Improving Hospital response to the current Opioid Crisis

Far too often, emergency departments become revolving doors for community members with substance use disorders, particularly for those with opioid use disorders and who are fortunate enough to survive an overdose. Hospitals are not drug treatment centers, yet for many with behavioral health conditions, due to difficult-to-navigate systems of care, we are a front door to accessing needed services, as inefficient and as wasteful as that might be. So what is an organization to do? In addition, how can hospitals most effectively respond to our current opioid epidemic equitably? 

I recently chaired the Racial Disparities in Overdose Task Force for the State of Maryland’s Inter-Agency Heroin and Opioid Coordinating Council. The task force was composed of state government representatives, non-profit organizations, and various advocacy groups. Our charge was to identify programs and policies that would eliminate the growing disparity in opioid deaths among the Black community.

I am fortunate to work in such a collaborative state strategically focused on addressing increases in opioid deaths in all communities. Despite significant effort and spending, since 2017, opioid overdose deaths have continued to increase disproportionately in the Black community in Maryland as it has across the nation. Given that efforts are not having the desired impact on this focused community, it is critical to look at more targeted approaches to slow down the rate of increase in opioid overdose deaths, thereby decreasing the growing disparity.

There is a role for many different participants in the healthcare ecosystem to combat and reverse this trend of increasing opioid overdose deaths. We concluded that hospitals could help decrease opioid death disparities by supporting low-barrier access to treatment services and leveraging individuals with lived experience as credible messengers.

Evidence-based treatment of opioid use disorders with FDA-approved medications saves lives. They are the most effective forms of treatment, yet only a fraction of non-white patients (less than 15%) receives them. 

There have been positive studies demonstrating the effectiveness of initiating treatment for opioid use disorders in emergency departments and inpatient medical/surgical units, which lead to significant rates of community treatment engagement, and decreased opioid-related hospital use. When hospitals identify that a person has an opioid use disorder, we must ensure that patients are referred and connected to treatment programs/providers. Supporting continuity of treatment promotes treatment retention and is associated with decreased risk of opioid overdose death and a whole host of other health-related benefits.

With the availability of telehealth, mobile opioid treatment, and now the elimination of the X-waiver, this is now easier to do than ever before.

There is ample evidence of the positive impact that those with lived experience can have on a person with a substance use disorder. Peers are in a position to support individuals living with substance use disorders in navigating the behavioral health system, addressing SDOH needs, and providing numerous other supports and benefits that promote recovery. They represent a low-cost, high-impact investment, and hospitals should advocate for reimbursement of their critical services.

These particular recommendations are generalizable to all populations.  However, given the harmful stigma associated with having/treating a substance use disorder, and the lack of awareness among the Black community of treatment options beyond methadone, opportunities to educate people who have SUD about their treatment options, to initiate treatment, and to connect them to community providers must not be missed. Taking advantage of these opportunities will support more equitable healthcare access and support non-hospital-based efforts to decrease opioid overdose deaths.

Though chronic disease management occurs best in the community, when people who otherwise don’t present for care enter the hospital setting, it is best for the individual and our communities at large to engage them in a supportive way and to provide, encourage and support evidence-based life-sustaining treatment, as we do for all other medical conditions.

Lastly, while at a listening session within the past year, I heard the story of a mother whose son presented to his local hospital with an opioid use disorder. He had regularly used the emergency department for complications associated with his addiction, namely overdose reversals. This particular hospital did not have a peer, nor did they initiate opiate use disorder treatment in the ED, nor did they make immediate referrals to care post-discharge, despite the son and his mother asking for help for his addiction. After one of these hospital encounters, he overdosed and died, to the devastation of his family. The hospital may not have been able to save his life in the long run, yet, they certainly could have given him a better, fighting chance and initiated life-saving treatment, and more assertively connected him to outpatient care. Situations like this happen everywhere, every day, and they need not. We can do better, and we should.