A VISION FOR THE FUTURE
A Public Health Approach to an Epidemic of Addiction
Addiction is not a criminal justice issue but a public health issue which requires specialist training and insight into the medical and biopsychosocial nature of the illness.
Let’s transform the way in which vulnerable, people at risk access addiction healthcare. People have a right to be treated, not dismissed, and discharged.
However, due to cutbacks, long waiting times and lack of experienced in addiction trainings first responders, doctors, nurses and associated healthcare workers, people are being turned away instead of receiving treatment.
It is not good enough to say implementing addiction healthcare will cost millions, addiction and mental healthcare are already costing billions globally:
loss of income, loss of family, loss of life.
I am committed to overcoming prejudice, stigma, isolation and shame by personally striving for 24/7 within established A&E NHS Hospital settings, accessible inpatient and outpatient addiction public healthcare programmes to combat the opioid crisis, treat addiction and COD: the coexistence of both a mental health and a substance use disorder is referred to as co-occurring disorder.
ADDICTION HEALTHCARE RIGHTS & RECOVERY
Recovery-oriented care is prevention, intervention, medically assisted detox, inpatient and outpatient continuing support, and connecting with a recovery community. Recovery is a way of life, an attitude, and a way of approaching life’s challenges. The need is to meet the challenges of one’s life and find purpose within and beyond the limits of addiction while holding a positive sense of identity.
Since the inception of Alcoholics Anonymous in 1939, clinical and recovery evidence demonstrates that when people engage in primary care addiction treatment, they have better outcomes than those not retained in treatment. Providing a safe place in which at risk, vulnerable people can be given a choice to engage in treatment is addiction healthcare human right.
Addiction is characterized by an inability to consistently abstain or reduce substance use, impairment in behavioural control, craving, tolerance, and interference with interpersonal relationships, occupational responsibilities, recreational activities, and emotional response.
Like other chronic diseases, addiction often involves cycles of relapse and remission and recovery is about connection – lets engage vulnerable, isolated and disenfranchised, at risk people to a compassionate addiction healthcare care regimen.
Otherwise, without treatment or engagement in recovery activities, addiction is progressive and will often result in disability, or premature death.
And while the cost of addressing every facet of the addiction crisis is substantial, the cost of doing less than what is absolutely necessary is far more.
TOGETHER WE CAN: strengthen our nation’s addiction prevention and treatment infrastructure and expand access to evidence-based care is working in partnership with addiction trained clinicians to pursue bold, systemic solutions.
There is no time left for incremental policy changes – we need to come together as a UNITED KINGDOM to both implement and fund addiction healthcare programmes that will comprehensively combat untreated, complex, co-occurring chronic disease of addiction.
I will be updating on the 20th January, 2020 the compassionate care Addiction & Mental Healthcare initiative vision into four main parts:
Objectives: to actualise a addictions training network among a group of A&E- NHS- hospitals that will voluntarily commit to expanding their response to the opioid epidemic and sharing their experience with the network.
I have identified three overarching aims which I would like Addiction & Mental Healthcare initiatives to achieve:
CONNECTION. COLLABORATION. COMMUNITY
The Vision: Inspire change, educate, empower and clinicians, and healthcare professionals best practice in the treatment of vulnerable at-risk people who are seeking help.
I have identified conscious objectives which should enable the aims to be delivered. There are interdependencies between the objectives, the aims and the overall outcomes to be achieved.
The objective is to:
Ensure that at-risk people are supported at all stages
of addiction and mental healthcare programmes.
Address the incidence and impact of trauma in all its forms
Support individual and family recovery
This plan will be accompanied by a primary compassionate care plan which will contain details of treatment which will be undertaken to achieve the objectives and identify who is responsible for delivering them.
A compassionate approach will aid the achievement of each of the aims, objectives and outcomes. These define key innovative ways this plan will work. The approaches are:
- Implementing addiction medicine trainings for doctors, nurses, clinicians, first responders, and associated healthcare professionals.
- Communicating and linking with peer-led recovery communities.
- Collaborating with NHS partners.
- Being innovative.
- Delivering efficient services.
- Operating strong governance and accountability arrangements.
- Clinicians and lived experiences volunteers working side by side.
- Communicating and linking with peer-led recovery communities.
POLICY AND INDUSTRY
For Hospitals, A Blueprint for Fighting the Opioid
A new report collects evidence-based strategies to help hospitals stem the tide of opioid use and overdose deaths.
Getty Images By Michael Botticelli, Donald M. Berwick, Maia Gottlieb, Mara
December 20, 2019
Hospitals are on the front lines of the opioid epidemic. Nearly 500,000 people with an opioid use disorder (OUD) are discharged from the hospital each year. Rates of opioid-related emergency department visits and inpatient stays have risen dramatically, as have rates of serious infections such as endocarditis and hepatitis C stemming from opioid use. Total hospital costs related to opioid overdoses have been estimated at $2 billion annually.
These stark statistics show the mounting pressure on hospital capacity and resources. But the numbers also reveal the tremendous opportunity hospitals have to influence the opioid epidemic. No other setting provides as many touchpoints to engage people with OUD and connect them with effective treatment.
For any hospital, transforming OUD treatment is a challenge. Fortunately, hospitals have more access than ever before to a wide array of evidence-based tools and strategies, ranging from effective medications for opioid use disorder to detailed guidelines for opioid prescribing. As the evidence for these and other best practices increases by the day, the urgency increases as well. With so many best practices available to us, hospitals cannot delay in creating a systems-level approach for addressing the opioid epidemic.
To help hospitals meet the need and overcome challenges, the Institute for Healthcare Improvement (IHI) and the Grayken Center for Addiction at Boston Medical Center teamed up to document effective strategies that hospitals can put in place to respond to the opioid crisis and support their patients. The resulting report, a synthesis of evidence-based guidelines and lessons learned from around the country, serves as a blueprint for hospitals.
The blueprint: Key strategies
Many hospitals across the United States are already responding to the opioid epidemic in strategic and innovative ways. The full IHI/Grayken Center report contains dozens of these examples, along with specific actions hospitals can take. Below are three broad areas in which hospitals can have an immediate impact.
Identifying and treating individuals with OUD at key clinical touchpoints
The emergency department (ED) remains an underused touchpoint for treating acute withdrawal and initiating treatment. EDs everywhere should be equipped to provide this frontline care. (In some states, including Massachusetts, this standard of care is already required by law.) Medication initiation in the ED works. When patients are given buprenorphine in the ED and referred to ongoing treatment (versus screening or referrals alone), they are more likely to remain in treatment and reduce their use of illicit opioids after 30 days, research from the Yale School of Medicine has shown.
Given the rise of opioid-related inpatient stays, addiction consult services are another key opportunity to reach patients and connect them to ongoing care.
These services, which engage patients during acute hospitalizations and often provide key harm reduction, have the capacity to improve care quality and reduce readmissions.
Hospitals often cite the lack of community-based referral capacity as a barrier to implementing substance use disorder services.
However, successful models exist for growing ongoing care capacity internally. For instance, office-based addiction treatment, developed first at Boston Medical Center, centers around a nurse care manager model of primary care in which nurses oversee patient care and offer medications for OUD such as buprenorphine when appropriate.
This model keeps patients engaged, destigmatizes the experience, and minimizes disruption to patients’ employment and other responsibilities. Research from Marc Larochelle, MD, at Boston Medical Center and others found that medication for opioid use disorder (specifically, buprenorphine and methadone maintenance treatment) was associated with reduced opioid related mortality and all-cause mortality over several months.
The office-based addiction treatment model has already spread throughout the country, and the “Massachusetts Model” treats hundreds of patients, with dozens of community health centers adopting the model.
Changing the way that hospitals treat pain:
Many hospitals have already responded to the opioid epidemic by rethinking how they prescribe opioid medications—often reducing the number of pills prescribed—and the settings in which they’re prescribed. The Michigan Opioid Prescribing Engagement Network, affiliated with the University of Michigan, has been a leader in the field, bringing together hospital systems and clinicians to develop evidence-based prescribing guidelines, encourage safe opioid disposal, and develop patient education materials.
However, in some cases the increased attention has led providers to be overly wary of prescribing opioids, to the point that the Centers for Disease Control and Prevention (CDC) decided to clarify that there are many situations where opioids are indeed appropriate.
Providers are also learning to emphasize alternative medications and treatments for acute pain management and newly identified chronic pain.
For patients already on high-dose chronic opioids, providers should cautiously manage those prescriptions; abruptly tapering patients is not clinically advised. Prescription drug monitoring programs are now regularly required by state governments, and pharmacies have become crucial partners in using existing data to identify patients, providers, and prescribers who may need additional attention. While this requires oversight to be effective, it represents true progress.
Clinicians are being more thoughtful about how to prescribe opioids effectively and safely, and hospitals are beginning to incorporate this thinking across specialties—from primary care to dentistry to post-surgical care. In Massachusetts (as well as a few other states) there’s a phone line that clinicians can call with prescribing questions.
Training stakeholders on the risks of OUD and how to reduce stigma
The prevalence of substance use means that many more individuals than ever before need to learn about opioid use, opioid use disorder, and substance use disorder more generally.
This includes not only people working in addiction medicine, but health care professionals outside of the addiction sphere, patients, and the public at large. Widespread stigma around opioid use disorder and the medications to treat it persists, even among medical professionals.
A survey from RIZE Massachusetts found that only one in four providers had received training on addiction during medical education. Startlingly, less than half of providers in emergency medicine, family medicine, and internal medicine believed OUD is treatable.
The stigmatizing attitudes about patients with substance use disorder among medical providers are well documented, and the consequences are severe, leading to the undertreatment of patients with substance use disorders. This stigma leads them to hesitate before sharing important information about their substance use with providers for fear of judgment and retribution.
It may also cause patients to use drugs in secret, which could lead to a fatal overdose or cause people with an OUD to forgo potentially lifesaving drugs, such as methadone or buprenorphine, because of the negative stories they may have heard.
Hospitals, given their direct line to patients, families, and employees, can dismantle this stigma. One way to do this is to teach all faculty and staff the facts about substance use disorder.
Another is to encourage a hospitalwide commitment to using clinically appropriate terminology—for example, referring to “people with a substance use disorder” rather than “addicts.” Hospitals can also be incubators for positive community change.
As employees unlearn the stigma they’ve been taught, they’ll share this view with family and friends, helping the community at large to reframe the way they think about addiction.
Hospitals working together
Some hospitals—including those we highlight in the report—have done all this and more; others are just beginning to take a systematic approach to taking on the opioid epidemic. In either case, the efforts to date have largely been independent and disconnected.
To achieve the size, scale, and sense of urgency needed to turn the tide of the epidemic, hospitals must work together to accelerate learning and secure buy-in from their organizations.
To turn the tide of the epidemic, hospitals must work together to accelerate learning and secure buy-in from their organizations.
In the next phase of our partnership with the IHI, we will be using the IHI’s Leadership Alliance to formalize a learning network among a group of hospitals that will voluntarily commit to expanding their response to the opioid epidemic and sharing their experience with the network.
Invariably, as hospitals band together, we will encounter policy and payment barriers.
The learning networks we develop to scale effective strategies can also be used to advocate for policy and practice change. The willingness to work together collaboratively will continue to be essential as hospitals collectively heed the call and assume a leadership position in fighting the opioid epidemic.
Authors’ Note As noted in the piece, the Institute for Healthcare Improvement and the Grayken Center collaborated on a report outlining effective strategies for hospitals to address the opioid epidemic. Neither party received financial compensation for their input on this report.
This article originally appeared on the Health Affairs Blog (12/20/19), 10.1377/hblog20191217.727229. Copyright © 2019 Health Affairs by Project HOPE – The People- to-People Health Foundation, Inc.
Topics: Opioids |