309 Overcoming Brick and Mortar: Feasibility of Implementation of a Medication for Addiction Treatment and Linkage to Treatment Program by Leveraging Community Partnerships

Abstract

Substance use disorder (SUD) annually costs the US over $440 billion. Medication for addiction treatment (MAT) helps manage withdrawal and cravings to reduce relapse and promote engagement in psychosocial interventions that promote healing. Implementing MAT and a linkage to treatment program in the hospital setting can improve care for SUD patients. Our Department of Emergency and Hospital Medicine implemented a protocol to screen and identify patients with SUD. A county-supported warm handoff approach began using screening, brief intervention, and referral to treatment to link patients with treatment options. Since 2017, a county-funded hospital opioid support team (HOST) provided a bedside level of care assessment and warm hand off to treatment. Also, a hospital-employed addiction recovery specialist (ARS), who is a licensed social worker and certified recovery specialist, provided bedside motivational interviews and care management. On July 1, 2018, a MAT program began with free county-supported interventions: seven-day discharge supply of buprenorphine and a transportation voucher. MAT is maintained by a partnership with a local drug and alcohol treatment center staffed by our MAT-trained toxicologists, where patients also receive individual/group counseling, certified recovery specialist support, and psychiatric treatment. Since January 2018, 1363 patients were linked to treatment through the ARS (218 patients) and HOST (1145 patients). Since July 2018, 123 patients were linked to treatment by the ARS: 54.97% to outpatient treatment, 10.48% to inpatient treatment, 4.22% discharged home with referral to inpatient treatment, 3.46% to a psychiatric/dual diagnosis facility, and 16.81% refused services. Over 70% of those evaluated by ARS since July 2018 were initiated on MAT. During January-March 2019, 62% of initiated patients received buprenorphine/naloxone, 15-17% received oral or intramuscular naltrexone, and up to 3% received acamprosate. Of those induced on MAT, 92 followed up at the MAT maintenance clinic during July 2018-March 2019, 71 of which received care management by the ARS. During July 2018-February 2019, most common dispositions by HOST were: 17.82% to detox facility, 11.2% to intensive outpatient treatment, and 9.52% to short- or long-term residential facility. An institutional linkage to treatment initiative with warm handoff to SUD treatment and induction/maintenance of MAT provides a solution that transcends the brick and mortar limitations of a hospital setting. HOST is a collaboration with local county drug and alcohol authority; and ARS combines care management and peer recovery support. Embedding MAT prescribers in a local drug and alcohol treatment facility ensures follow-up for hospital MAT initiated patients.