What Happened When a Portland Hospital Started Treating Addiction Like Any Other Illness

Gizmodo.com – April 25, 2018

Over the past few years, a hospital in Portland, Oregon has dramatically shifted its approach to treating patients with substance use disorders, including opioid addiction. And since then, the hospital has undergone a “sea change” in the way its medical staff think about and address addiction, according to a study published Wednesday in Journal of Hospital Medicine.

For years, Honora Englander, an assistant professor of medicine at Oregon Health & Science University (OHSU) as well as a physician at its attached hospital system, saw patients suffering from addiction slip through the cracks. They’d seek medical help for a complication related to their substance use, like an infection, leave, then be readmitted for another complication months later. Often, the cycle would tragically end in an early death.

So Englander and others began trying to create a program that could fill in the gaps. Her initial survey of patients living with addiction found that most—two-thirds—wanted to either quit or cut back on their substance use, and that many wished they had the opportunity to start treatments like medication-assisted therapy (MAT), which provides therapy alongside prescribed drugs like methadone and buprenorphine that reduce craving and withdrawal symptoms, right in the hospital.

Based on this feedback from patients as well as providers, she and others spearheaded an initiative within OHSU known as the Improving Addiction Care Team, or IMPACT, program in July 2015.

Through the program, doctors can refer willing hospitalized patients to a dedicated crew of doctors, social workers, and counselors. They might indeed start on MAT in the hospital, then be transitioned over to community providers who can help them continue their treatment immediately after they leave. They might also meet with peer mentors who themselves have dealt with addiction that can provide them emotional support, as well as social workers.

In the current study, Englander and her team conducted interviews with over 30 healthcare providers at OHSU to see how they felt about the program and their patients since it started.

“What we found was that prior to our work, there was this sense of futility from individual providers across disciplines. The other thing we saw was this sense of chaos and frustration,” Englander told Gizmodo. “But by modeling compassionate bedside care, by introducing medications that alter the brain disease of addiction, we changed the culture.”

While the researchers are still collecting data about how the program has affected patient outcomes, their newly published work shows how IMPACT changed many providers’ minds about the nature of addiction.

“We were sort of surprised by the reactions some healthcare providers had. They often described it as a sea change,” said co-author Christina Nicolaidis, a fellow physician and associate professor of medicine and public Health at OHSU. “With the IMPACT model, people were really able to see how this is like any other disorder that we treat in the hospital. That with the appropriate expertise, policies and procedures, we can actually make a difference.”

As important as it has been to destigmatize addiction, Englander says the program highlights a much larger failing surrounding the public health crisis.

“We have this disease that killed more people than the entire Vietnam war in 2016, yet hospital systems in general don’t have the appropriate systems in place,” she said, referring to the record high 60,000 deaths caused by drug overdose that year, which outnumbers the 58,000 deaths of American troops seen during the war. “So these are structural, not individual issues.”

The team is now studying how patients have responded to the program, both through interviews taken while they were enrolled in the hospital and by examining their medical records after they left. But Englander says she’s already seen tangible improvements among the 850 patients the program has taken on since it began.

“We’ve had stories of young women who have been reunited with their children, engaged in treatment, and gotten their first set of keys to a new home or apartment,” she said. In other cases, the program at least allowed patients to complete a full course of treatment for other health problems that they might have missed otherwise, preventing costly readmissions.

Englander and her team are now in the process of expanding elsewhere. Through state funding, they’ve set up a program where local doctors can have their cases reviewed by IMPACT members via a weekly video teleconference and get treatment recommendations. Later this fall, they plan to include hospitals that serve small, rural communities.

“Our experience is that the interpersonal nature of [the IMPACT model] is very valuable, but we also understand that in smaller communities that might not be possible—you know, there might be only one social worker at a hospital,” Englander said. “So we want to provide a platform where, whatever the local tendencies might be, you’re welcome to participate and cross-train.”

Of course, the program has its limitations, namely that it can’t do anything to address broader problems like poverty that make people more vulnerable to addiction. And though up to 15 percent of OHSU hospitalized adult patients have a substance use disorder, according to Englander, the IMPACT team only tends to see the more severe cases.

But in the face of an ongoing crisis that has shortened US life expectancy twice, and with an estimated more than 2 million Americans currently suffering from an opioid use disorder, Englander believes the IMPACT program is a step forward, one that other hospitals across the country should adopt.

“This is the right thing to do for so many reasons. We know that medication services can save lives, and we need to be able to provide that in a hospital setting,” she said. “If someone is admitted to the hospital with a diabetic foot infection and needs an amputation, we don’t cut off their foot and not treat their diabetes. And the same really needs to be true for addiction.”