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Hospitals turn to collaborative agreements to battle addiction crisis

Dr. Larry Graham couldn't handle sending one more patient showing signs of substance abuse home without a clear path for follow-up treatment. He and his colleagues would try to secure appointments with addiction specialists only to come up empty or add them to a waitlist.

Hospitals are teaming with community-based behavioral health providers to hasten access to treatment for patients battling addiction.

"We were reinventing the wheel every time someone came in or putting them on waiting lists, which we all know is really a death list," said Graham, president of the Behavioral Health Institute at Mercy Health, a system of hospitals based in Ohio. Eight to 10 people per day come in to the Mercy emergency department with drug overdoses. Often these patients would make repeat trips to the ED until they either got into a recovery program or died from an overdose.

To stop the cycle, Mercy began reaching out to addiction treatment providers last spring in hopes of expediting access to treatment. As of now, it has 10 collaborative agreements in place.

Mercy Health provides short-term, hospital-based detox before it transitions patients to an outpatient partner for long-term, medically assisted treatment and support. "Now, thanks to this collaborative agreement, calls are answered and people are getting the care they need," Graham said.

Instead of waiting days or longer to secure appointments at a recovery facility, people are able to immediately begin treatment, leaving no gaps in their care and much less potential for lethal relapses, Graham said. If a place is at capacity, addiction providers in the collaborative refer that patient to another facility.

The effort formally launched in November, but Graham did not yet have figures for how many patients have moved along the pathway.

Ohio has been hit harder than most other states by the opioid epidemic. From 2000 to 2015, the death rate due to unintentional drug poisonings increased 642%. Opioid-related overdoses are largely driving the increase in fatalities, according to state data. On average, about eight people die each day in Ohio due to unintentional drug overdose.

Berger Health System in Circleville, Ohio, is involved in a similar collaborative known as the Pickaway Addiction Action Coalition. Leaders at both Mercy and Berger understand that while hospitals play a central role in combating substance abuse, they can't do it alone.

PAAC differs from Mercy's efforts in that there's not only an avenue to coordinate and collaborate with addiction providers, but also with social service, criminal justice and community stakeholders. "With substance use disorders it's so big a challenge that if any one stakeholder tries to solve it themselves it would crush them," said Tim Colburn, CEO of Berger.

Increased focus on substance abuse has also given hospitals an opportunity to better educate physicians about the needs of patients battling substance abuse and the best techniques to help them get the care they need.

"The nurses and ED providers really wanted to help these patients but didn't feel they had the tools they needed," said Dr. Jill Barno, Berger's chief medical officer.

Berger is working with the not-for-profit Addiction Policy Forum to develop assessment tools to help its providers better identify patients who may have substance use disorders, no matter why they show up in the ED.

They are also working together to develop effective post-overdose interventions for its patients after medical stabilization in the ED. These include naloxone training for patients and their families, as well as handoffs to a provider in the community for a comprehensive assessment to develop an individualized treatment plan.

There is hope that other hospitals will enter or launch collaborative agreements with behavioral health and other providers to hasten access to treatment.

Nearly 65,000 people nationwide died from overdoses in 2016, up 21% over the year before according to the Centers for Disease Control and Prevention; 70% previously had a nonfatal overdose.

"What we are lacking is the protocol in healthcare to make sure nonfatal overdoses are an intervening moment," said Jessica Hulsey Nickel, CEO of the Addiction Policy Forum. Collaborative agreements "are the most efficient way to help these patients and save lives."

Virgil Dickson reports from Washington on the federal regulatory agencies. His experience before joining Modern Healthcare in 2013 includes serving as the Washington-based correspondent for PRWeek and as an editor/reporter for FDA News. Dickson earned a bachelor's degree from DePaul University in 2007.

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