By Olivia Ramirez
Many people with opioid use disorder (OUD) come in contact with the healthcare system for issues related to their illicit opioid use. Often, people present to the emergency room with an opioid overdose, or superficial or deep-seated infections due to injection drug use. Many of these infections require lengthy hospitalization and sometimes surgical intervention.
When patients receive treatment for medical complications related to OUD and injection drug use, they may not receive treatment for the underlying substance use disorder. By failing to address the underlying cause of the medical complications, patients remain vulnerable to reinfection, readmission and death.
A New Plan
When the state began looking for ideas to address the opioid epidemic in Kentucky,
Drs. Sharon Walsh, Michelle Lofwall and Laura Fanucchi, of the University of Kentucky Center on Drug and Alcohol Research (CDAR), submitted a plan to help patients who were engaging with the medical system enter treatment.
Through the new First Bridge Clinic, located at CDAR, Walsh, Lofwall and Fanucchi are creating a new setting where patients can receive evidence-based care for OUD. Patients may receive FDA-approved medications for opioid use disorder, counseling services and monitoring aimed to promote remission and recovery. Referrals for more intensive treatment can also be provided to patients.
“An essential part of the substance use disorder treatment system is to be able provide treatment-on-demand rather than sending patients who are at risk for overdose death to treatment waiting lists,” Fanucchi said. “This way we can engage patients and link to treatment at the moment of contact with the healthcare system and hopefully reduce substance use related morbidity and mortality.”
Transitional Care Provided
In partnership with the emergency departments at UK HealthCare and with financial support from the state through the 21st Century Cures Act, Walsh, Lofwall and Fanucchi are creating a clinical setting where providers in the emergency department can refer patients to receive transitional care for OUD.
Roger Humphries, chair of the department of emergency medicine at UK HealthCare has worked with his team of physicians, nurses and social workers to implement and improve the referral system from the emergency room to the First Bridge Clinic.
Currently, patients who present to the ER with complications related to OUD are provided a flyer with information about the clinic including how to begin treatment there. If the patient is cooperative a clinician will assist them with making a call to the clinic on the spot.
Though clinicians trained in emergency medicine might not be trained in addiction medicine, Humphries believes it’s important for them to intervene and assist patients with treatment for any substance use disorders they may have. He said, “We see the complications and how it destroys peoples’ lives. We’re the front line and have the opportunity to intervene and educate. For many people, the ED is their main source of healthcare; if we don’t intervene no one will.”
We’re the front line and have the opportunity to intervene and educate. For many people, the ED is their main source of healthcare; if we don’t intervene no one will. – Roger Humphries, chair of the department of emergency medicine at UK HealthCare
Additionally, Walsh, Lofwall and Fanucchi will share information with facilitators from the two other sites in the state also awarded funding to create similar clinics.
“The need for this clinic is clear,” Lofwall said. “If the underlying addiction isn’t treated the person goes back to active addiction and is at very high risk for death and/or reinfection requiring another hospitalization with complicated medical and surgical treatments.”
While the clinic was developed in response to the opioid epidemic currently raging in the United States, patients with any substance use disorder, or multiple substance use disorders can receive treatment.
In creating this new multidisciplinary service, the team at UK is hoping to positively impact the opioid epidemic by expanding and improving access to recovery services for patients.