The University of Vermont Health Network – Central Vermont Medical Center secures new grant to continue innovative response to opioid crisis in partnership with the Washington County Substance Abuse Regional Partnership.
Central Vermont Medical Center (CVMC) was recently awarded a $200,000 Rural Communities Opioid Response Program-Planning grant from the U.S. Department of Health and Human Services to build on the strong partnership created between the Emergency Department (ED) and community substance-abuse prevention, treatment and recovery programs throughout Washington County.
“Great work is being done as we continue to collaborate on ways to confront the opioid crisis and other substance use disorders,” says Javad Mashkuri, MD, medical director of emergency medicine. “With the grant funds, we’ll hire a coordinator and move our Washington County Substance Abuse Regional Partnership (WCSARP) to a new level of regional engagement and proactive planning.” The new work will begin with a needs assessment and then development of a strategic plan to help achieve greater health throughout Washington County.
Since 2013, CVMC has been pioneering local efforts to address substance use in the ED, when it launched the Screening, Brief Intervention, and Referral to Treatment program. Funded by a federal grant, the program conducted universal screenings with all ED patients to learn about their tobacco, alcohol and drug use. An essential element of the program embedded full-time drug and alcohol counselors in the ED to help patients to understand their risk level around substances and consider changing patterns of use likely to result in health problems. Further, the counselors worked with patients wanting treatment, which ranged from follow-up counseling outside the ED to referrals for residential treatment.
“That project transformed the outlook of dealing with substance use in the ED,” Dr. Mashkuri says. “It finally gave us something we could do for patients struggling with addiction.”
He explains, “People who struggle with substance use pose challenges to routine care. Substance use is very disruptive to their lives – sometimes it costs them their family, their job, their place to live — and quite often there’s also underlying health issues. In the ED, we try to see problems and fix them and get patients on their way. Initially, we really didn’t have a lot to offer them. Once we saw that we had clinicians on our team that were going to take the time to sit down and figure out with patients what resources were available and start connecting them, it was very empowering for us.”
Dr. Mashkuri and his colleague CVMC Regional Physician Leader, Mark Depman, MD, also realized that they were unfamiliar with all of the substance-use treatment and prevention resources in their own community to whom the ED patients could be referred. They began an outreach effort that ultimately brought all of the entities together in the group known as WCSARP for monthly meetings over a working lunch at the hospital.
The strength of the relationships formed within the partnership, as well as the progress made with the screening and treatment program, set the stage for CVMC’s success in July 2018 when it became the first ED in the state to use buprenorphine to treat patients with opioid use disorder (OUD). Buprenorphine is a medication that eases the symptoms of withdrawal, alleviates cravings, and allows patients to return to productive lives. The initiative, called Rapid Access to Medication-assisted treatment, or RAM, is federally funded and supported by the Vermont Health Department. “At our meetings, we talked it over with our local clinic leaders and said we would be willing to start treating patients in the ED with buprenorphine if we could get them a guaranteed follow-up at their clinics within three days. They said absolutely,” Dr. Mashkuri says.
At the same time, a complementary initiative launched that pairs the Turning Point Center of Central Vermont with CVMC’s ED to bring peer recovery coaches in to work with patients. Dr. Mashkuri stresses the importance of these coaches, who respond within 30 minutes of receiving a page and have become key to the success of the program: “Not only do the coaches help patients through the process here, but they keep checking in to ensure that they receive follow-up care. Recovery coaches are positive role models to both patients and staff about what is possible and what successful recovery looks like. They help give people a lot of hope.”
Hilary Denton, a peer recovery coach who struggled in the past with substance abuse disorder, says her own experience seems to resonate with patients. “A lot of people carry a lot of shame whether they know it or not. Learning that I’m in recovery helps diffuse that,” she explains. She said patients often thank her for her understanding, and tell her they appreciate her nonjudgmental approach.
Over the past year the recovery coaching program has seen promising results. In addition to the 120+ patients who have been connected to treatment for OUD, another 185 have received help with alcohol use disorder, and a few dozen more have worked with the coaches regarding other substances. Of the 80 patients served with RAM, an impressive 82% made it to their clinic appointment with an addiction specialist, according to Katherine Higgins, a health support navigator who tracks the program. “They’re ready, and they’re getting immediate access to medication and an addiction specialist,” she says. “We’re working hand-in-hand with partner providers and that’s what has made it so successful. It’s awesome collaboration, communication and continuity of care.”
This story was reported by Kim Asch, with the UVM Health Network.