For many diseases, hospitals provide on-call support, but addiction is not one of them

Marie resides in the Massachusetts coastal community of Swampscott. In December of last year, she experienced increasing difficulty breathing. Three days after Christmas, she awoke one morning gasping for air. A voice in her thoughts stated, “You will perish.” Marie dialed 911.

“I was really terrified,” Marie subsequently stated. The 63-year-old woman’s voice grew tense as she described that day, and her palm clenched her chest.

Marie was admitted to the hospital located north of Boston. COPD, a chronic lung illness that encompasses emphysema and chronic bronchitis, was treated by the team.

The next day, after her severe symptoms had eased, a doctor arrived to check on her. He informed Marie that her oxygen levels appeared healthy and that she was ready to be discharged from the hospital.

NPR does not use Marie’s last name since, like, she has a history of drug or alcohol abuse. Disclosing such a diagnosis can make it difficult to acquire accommodation, employment, and even medical care in hospitals, where individuals with an addiction may be rejected.

However, after speaking with the doctor that morning, Marie felt she had no choice. She was required to inform him of her other medical condition.

“He stated that my liberation was possible,” Marie recounted. “And I said, ‘I have something to tell you. I am an opiate addict. And I’m beginning to experience severe withdrawal symptoms. I can’t physically move, so please don’t force me to leave.'”

Without care, patients run risk of overdosing upon discharge.

In many hospitals in Massachusetts and around the world, Marie would have been discharged while still experiencing withdrawal symptoms. She might leave with a list of local detoxification programs where she might or might not find assistance.

However, a vital opportunity to intervene and treat in the hospital would have been wasted, in part because the majority of hospitals lack addiction specialists and other professionals are clueless.

Typically, hospitals employ a variety of specialists who focus on vital organs such as the heart, lungs, and kidneys, or who treat systemic or chronic diseases of the immune system or brain. There are experts in pediatrics, mental illness, birthing, and hospice care.

But if your ailment is an addiction or a condition related to drug or alcohol use, there are places where patients can see a practitioner who specializes in addiction medicine, such as a physician, nurse, therapist, or social worker.

Their absence among hospital employees is especially notable at a time when overdose deaths in the United States have grown, indicating that patients face an elevated risk of deadly overdose in the days or weeks following hospital release.

“They’re left to sort it out on their own, which sadly means continuing [drug] use because it’s the only way to feel better,” explains nurse practitioner Liz Tadie.

Tadie debuted a new method at Salem Institution in the fall of 2020, utilizing $320,000 from a federal grant that the hospital had battled for years to get. Tadie established a “service for addiction consultation.”

This team at Salem consisted of Tadie, a patient case manager, and three recovery coaches who use their experience with addiction to advocate for patients and guide them through the treatment options available.

What a service for addiction consultation provides to the bedside

Therefore, on that day, when Marie implored, “Please don’t make me leave,” her doctor did not urge her to depart. He requested a bedside consultation with Tadie.

Methadone, a therapy for opioid addiction, was the initial drug prescribed by Tadie. Although many patients respond positively to this medication, it was ineffective for Marie, so Tadie moved her on buprenorphine, with improved results. Marie was eventually discharged and continued to take buprenorphine to treat her opioid addiction after a few more days.

However, Marie continued to attend Tadie as an outpatient for treatment and was able to rely on her for support and reassurance:

Marie stated, “Like I wasn’t going to be left alone.” “That I would never again need to phone a dealer, and that I could delete the number. I desire to return to my life. I just feel grateful.”

Tadie helped spread the word among Salem’s clinical team about her expertise and how it may benefit patients. Success stories like Marie’s helped her make the case for addiction medicine, which necessitated dismantling decades of misinformation, prejudice, and misunderstanding regarding addicts and their treatment.

According to Tadie, part of the problem is that doctors, nurses, and other clinicians receive inadequate training in the physiology of addiction and withdrawal, the drugs and treatment alternatives, and the developing scientific knowledge about what works for these individuals. What little training doctors and nurses do receive is frequently ineffective.

“Many of the facts are obsolete,” admits Tadie. People are also being trained to use stigmatizing vocabulary, such as ‘addict’ and’substance misuse.’

For instance, Tadie gently corrected doctors at Salem Hospital who believed they were never permitted to start patients on methadone in the hospital.

“Occasionally, I would propose a dosage, and someone would object,” Tadie adds. However, when we came to know the hospital doctors, they eventually said, “OK, we can trust you. We will adhere to your suggestions.”

Over time, addiction specialists contribute to a cultural shift

Other members of Tadie’s staff have similarly struggled to find their position in the hospital’s organizational structure. David Cave, one of the recovery coaches at Salem Hospital, is frequently the first person a patient in withdrawal who arrives at the emergency room speaks to. He attempts to assist physicians and nurses in comprehending the individual’s condition and navigating their care.

Cave states, “I am probably punching above my weight if I attempt to converse with a therapist or medical.” “They do not see the letters following my name. It can be somewhat difficult.”

According to Jean Monahan-Doherty, a social worker who has referred patients to Tadie, designating addiction as a specialty and hiring individuals with training in this particular condition is altering the ethos of Salem Hospital.

“Finally, the institution as a whole acknowledged that this was a medical condition requiring the attention of a specialist,” Monahan-Doherty says. “Humans are dying. This is a fatal illness if it is not treated.”

This method to addiction treatment is gaining the support of some Salem Hospital personnel, but not all.

Monahan-Doherty states, “Some of the medical professionals continue to view it as a moral issue.” “Sometimes you hear, ‘Why are you exerting so much effort with this patient?’ They are not going to improve. How then do we know? If a patient presents with diabetes, we do not reply, “OK, they’ve been instructed before and it didn’t work.” Therefore, we will no longer afford them assistance.'”

Despite some colleagues’ residual doubts, the demand for their services is fairly substantial. Tadie and her crew have been inundated with referrals for several days.

States experiment with federal funding to prevent overdose deaths

In the previous three years, four additional hospitals in Massachusetts hired addiction specialists and saw similar difficulties and successes. The additional personnel was funded by federal funds from the. This initiative is funding a variety of tactics in multiple states to find the best effective methods for preventing drug overdose deaths. They consist of mobile treatment clinics, street outreach teams, naloxone training and distribution, transportation to treatment facilities, and multilingual public awareness campaigns.

Dr. Jeffrey Samet, who oversees the Massachusetts section of this research endeavor, explains, “You truly do deliver better care for patients and make the care environment one where employees are more satisfied working.” Samet, a primary care physician at Boston Medical Center, asserts that bringing addiction specialists to hospitals is a crucial component of the answer.

Dr. Todd Kerensky, president of the, has witnessed patients crying upon learning that he specializes in addiction and seeks to treat, rather than shame, their sickness.

“It’s heartbreaking to realize that so many institutions lack this service,” says Kerensky. It is unclear how many Massachusetts hospitals employ addiction specialists, but according to Kerensky, it is a “distinct minority.”

There are numerous potential causes. As it is a new field, it may be difficult to obtain certified staff members with the necessary qualifications. Some hospital administrators are concerned about the price of addiction treatment and believe they will incur losses. Some physicians state that they do not want to commence a treatment drug while a patient is still in the hospital because they do not know where to direct patients after release, be it for outpatient follow-up care or a residential program. Salem Hospital established a “bridge clinic” to handle follow-up care, where patients receive assistance transferring to outpatient care.

In spite of these concerns and doubts, a national leader in addiction speciality programs asserts that hospitals without a team of addiction specialists must establish one.

“People with drug use disorder are increasingly visiting our hospitals,” said Englander, who oversees a team of addiction treatment specialists at Oregon Health and Science University. “We are impatient. We must improve, and this is the time.”

The federal government, according to Englander, might assist the expansion of addiction consult services by introducing financial incentives or penalties to hospitals that do not adopt them. The Centers for Medicare & Medicaid Services, which has regulatory authority over the majority of U.S. hospitals, could require hospitals to stock medications used to treat addiction and track outcomes for patients hospitalized with a substance use disorder, just as they do for patients with other health conditions.

The program is still new at Salem Hospital, and several employees are concerned about its sustainability. Liz Tadie is relocating to a new hospital, and the federal grant expired on June 30. However, the officials of Salem Hospital have shown their commitment to continuing the initiative, and the service will continue.

Salem Hospital has served the most patients of the four Massachusetts hospitals that started addiction consult teams utilizing the same government money. Over the course of 15 months, the team assisted 448 patients in initiating treatment for their opioid use problem.

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