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treatment and therapy to combat overdose deaths. “When we compare our results to other hospitals’ data, early outcomes of the pathway appear to show a reduction in the rate of patients leaving against medical advice,” Dr. Horton said. “We’ve been able to make an impact.”
Other health systems are noticing. In Huntington, West Virginia, a health system is working with Christiana Care to implement its own version of the pathway. Dr. Horton traveled to the city in August to help them address their opioid crisis and planned to return to West Virginia in December to deliver a grand rounds. West Virginia is among the states hit hardest by the opioid crisis.
“It’s greatly rewarding to know that the pathway we created here at Christiana Care is useful to others,” he said.
MEDICATIONS KEY TO OVERCOMING ADDICTION
The severity of opioid withdrawal is one of the main reasons that it’s so hard to quit. Opiates rewire the brain, and within hours after an addicted person stops using the drug, the brain responds with what Dr. Horton calls “primal misery.”
Thomas Bradford, MSW, a social worker with the Christiana Care Visiting Nurse Association, has heard much the same.
“The withdrawal is so painstakingly acute,” Bradford said, likening it to “horrible physiological agony.”
Often, an individual is faced with a choice between the agony of withdrawal and a cheap bag of heroin. But medication can stave off withdrawal and make that choice unnecessary.
A key part of the opioid withdrawal clinical pathway is consistent use of medications that mimic the neurological effects of opioids but without the accompanying intoxication.
Buprenorphine partially fills and blocks opioid receptors on neurons. It has about 40 percent of the effect of heroin, so it is much less likely to cause respiratory arrest and overdose death while alleviating the symptoms of withdrawal. When used daily, buprenorphine has been shown to reduce craving, opioid use and mortality.
Buprenorphine has been FDA-approved since 2003 but is still not used to its potential, Wilson M. Compton, M.D., MPE, deputy director of the National Institute on Drug Abuse, said at the symposium. In 2014, only 25 percent of opioid admissions included medication in their treatment plans. He said the government is looking to fund efforts that can increase use of these drugs, including through novel delivery solutions.
Dr. Horton said there is a misunderstanding, especially among the families of those with addiction, that buprenorphine treatment is just replacing one addiction for another. He tells them that addiction is a disease in which the victim takes drugs
despite their negative consequences. With buprenorphine, patients avoid the myriad negative consequences of other opiates, most notably overdose and death.
He distills the data into a simple safety message for his patients: “Every day you take buprenorphine is a day you will not overdose and die.”
To their parents, he says, “We are in a dangerous epidemic.
I know if your son or daughter takes their buprenorphine today they’re safe.”
IN 2016,
308 DELAWAREANS DIED FROM OVERDOSES
COMPARED TO 228 IN 2015.
PROJECT ENGAGE SETS THE STANDARD
Christiana Care’s opioid withdrawal pathway grew out of a program called Project Engage, an early intervention and treatment-referral program designed at Christiana Care to
help hospital patients who may be struggling with alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. It was recently highlighted as a best-practice model by the American Hospital Association in the toolkit “Stem the Tide: Addressing the Opioid Epidemic.”
Project Engage was based on the understanding that patients who are in the hospital — even for reasons unrelated to addiction — are often at a low point and open to exploring treatment for their substance use. The program integrates peers in their recovery — called engagement specialists — who meet with patients at the bedside and help to mentor them through their treatment options. | CONTINUED
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