A hospital emergency room program started to help patients get help with opioid addiction has found great success at Adventist Health/Rideout Hospital.
Since May, the Public Health Institute’s California Bridge Program has helped providers at the hospital assist more than 300 patients in receiving treatment for opioid use disorder.
The program bridges the gap between medical care and continued treatment by providing patients with medical assisted treatment (MAT) for withdrawal symptoms and then making appointments in outpatient clinics for continued treatment and support.
Dr. J. Eileen Morley, who serves as Bridge Program director and assistant medical director of the Emergency Department at Rideout, said before the program, the emergency room used anti-nausea medications for withdrawal patients and didn’t offer any follow-up.
“It’s really been the spring, before then it was, honestly, really frustrating for the patients and for us to find something that worked,” Morley said. “This is a complete 180.”
Rideout is one of 52 hospitals in the state to participate in the program, which provides hospitals with support, training and technical assistance to treat opioid use disorder.
Morley said the program has already exceeded expectations since being implemented this past spring.
“Of the people that get an appointment made, it’s just over 80 percent make it to their appointment,” Morley said. “When you consider how many people actually make it to their primary care appointments it’s significantly higher.”
How it works
Patients in the emergency room for opioid withdrawal are given a dose of buprenorphine (brand name Suboxone) which stops withdrawal symptoms in about 45 minutes. Then patients are connected to the hospital’s substance use navigator who schedules them into outpatient clinics. They are given enough Suboxone to last until their outpatient appointment which is usually within 72 hours of release from the emergency room.
One of the key components to the program’s success, Morley said, is substance use navigator Todd O’Berg, who is a certified addiction treatment and drug and alcohol counselor.
O’Berg meets with patients who come into the emergency room either for opioid withdrawal or are identified by hospital staff as having substance abuse issues.
“We have a brief conversation about which way they want to go – have they tried being in recovery before,” O’Berg said. “Then from that information, I try to decipher what the best course of action is.”
O’Berg will call outpatient clinics on behalf of patients so they have an appointment scheduled before they leave the hospital. Morley said that timing is important, because clinics require patients to actively be in opioid withdrawal and time the last dose of Suboxone to coincide with their appointment.
“One of the other things that makes it quite hard is when you’re in withdrawal from opioids you are so miserable you can’t do anything,” Morley said. “Trying to do it on your own, that’s very hard.”
O’Berg then follows up with patients through phone calls and reminders as needed to connect them to resources like transportation to appointments, or provide a word of encouragement. It’s all part of helping “carry the load” so people find success O’Berg said.
He said a success is his first patient at the hospital, a homeless man with a pregnant girlfriend who he’s kept in touch with since first working with him earlier this year.
“We were able to get him connected in the MAT treatment program and since then he has gotten a place to live, become employed, had a baby. He has moved forward with his life,” O’Berg said.
O’Berg said the program has a ripple effect which reaches past the individual being treated to the family as well. He used the example of a man who went through the program who had an addiction to painkillers, six kids and a business to run.
“We didn’t just save that one individual that day,” O’Berg said. “We saved those kids’ lives too.”
While critics may find concern with the notion of using one medication to stop the symptoms of withdrawal to another, Morley said Suboxone replaces the symptoms of an opioid without the high, and unlike opioids doesn’t have the same overdose dangers.
“It (Suboxone) has a respiratory ceiling ... if you take too many opioids you stop breathing, but you can’t with Suboxone,” Morley said.
She said 88 percent of the 36 emergency room providers have taken the x-waiver course mandated by the Drug Enforcement Administration so they can prescribe Suboxone.
While O’Berg’s position is funded through the program for the next 18 months, Morley said he isn’t going anywhere.
“We’re not going to stop his position because it’s been so wonderful for our community,” Morley said. “There is no end in sight.”
In addition to the Bridge program, the hospital is also partnering with a naloxone (brand name Narcan) distribution program. Naloxone is a nasal spray that reverses opioid overdoses. The hospital received 6,000 doses of the spray which they hand out freely and anonymously. Morley said the hospital has handed out 909 doses of naloxone so far.
Morley said both programs help the emergency room better help their patients.
“It’s really been great for patients obviously, and for staff,” Morley said. “Because we want to help people, and now we can.”
For information or help, call or text message Todd O’Berg at 490-1285 or email Todd.OBerg@Vituity.com.