Luminis Health

Aliya Jones

Hospitals are not drug treatment centers; however, for many with behavioral health conditions, due to difficult-to-navigate systems of care, we are a front door to accessing needed services, as inefficient and as wasteful as that might be. Far too often, emergency departments become revolving doors for community members with substance use disorders, particularly those with opioid use disorders who are fortunate enough to survive an overdose. So what is an organization to do? In addition, how can hospitals most effectively respond to our current opioid epidemic equitably?

I recently chaired the Racial Disparities in Overdose Task Force for the State of Maryland’sMaryland’s Inter-Agency Heroin and Opioid Coordinating Council. The task force was comprised of state government representatives, nonprofit organizations, and advocacy groups, including those advocating on behalf of hospitals. Our charge was to identify programs and policies to eliminate the growing disparity in opioid deaths among the Black community in the State of Maryland.

I am fortunate to work in such a collaborative state and a state strategically focused on addressing increases in opioid deaths in all communities. Despite significant effort and spending, opioid overdose deaths have increased disproportionately in the Black community in Maryland since 2017, much as it has across the nation. Given broad generic efforts are not having the desired impact on this focused community, it is critical to look at more targeted approaches to slow down the rate of increase of opioid overdose deaths, thereby decreasing the growing disparity.

"Given broad generic efforts are not having the desired impact on this focused community, it is critical to look at more targeted approaches to slow down the rate of increase of opioid overdose deaths, thereby decreasing the growing disparity  "

 There is a role for many different participants in the healthcare ecosystem to combat and reverse this trend of increasing opioid overdose deaths. The Taskforce concluded that hospitals could help decrease opioid death disparities by supporting expanding low-barrier access to treatment services and leveraging individuals with lived experience as credible messengers.

 Evidence-based treatment of opioid use disorders with FDA-approved medications saves lives. They are the most effective forms of treatment, and yet only a small minority of patients (less than 15%) are prescribed them.What’s more, the literature shows that African Americans are less likely to be offered these treatments.

There have been positive studies demonstrating the effectiveness of initiating treatment for opioid use disorders in hospital settings, including emergency departments and inpatient medical/surgical units, which in turn lead to significant rates of engagement in treatment post-discharge, as well as decreased opioid-related hospital use. When hospitals identify a person with an opioid use disorder, we must ensure that patients are referred and connected to treatment programs/providers. Supporting continuity of treatment in our communities promotes treatment retention, which is associated with decreased risk of opioid overdose death and a whole host of other health-related benefits. With the availability of telehealth, mobile opioid treatment, and now the elimination of the X- waiver as a barrier to prescribing, this is now easier to do than ever before.

There is ample evidence of the positive impact that those with lived experience can have on a person with a substance use disorder. Peers are in a unique position to support individuals living with substance.

Use disorders in navigating the behavioral health system and in getting social determinants need to be addressed, and they provide numerous other supports and benefits that promote recovery. They represent a low-cost, high-impact investment, and hospitals should advocate for reimbursement of their critical services.

These particular recommendations are generalizable to all populations. However, given the great stigma associated with having/treating a substance use disorder, and the lack of awareness among the Black community of treatment options beyond methadone, opportunities to educate people who have SUD about their treatment options, to initiate treatment, and to connect them to community providers mustn’t be missed. Taking advantage of these opportunities will support more equitable access to care and support non-hospital-based efforts to decrease opioid overdose deaths.

Though chronic disease management occurs best in the community, when people who otherwise don’t present for care enter the hospital setting, it is best for the individual and for our communities at large to engage them in a supportive way and to provide, encourage and support evidence-based life-sustaining treatment, as we do for all other medical conditions.

Lastly, while at a listening session within the past year, I heard the story of a mother whose son presented to his local hospital with an opioid use disorder. He had regularly used the emergency department to care for his addictionrelated complications, namely overdose reversals. This particular hospital did not have a peer, nor did they initiate opiate use disorder treatment in the ED, nor did they make immediate referrals to care post-discharge, despite the son and his mother asking for help for his addiction. After one of these hospital encounters, he overdosed and died, to the devastation of his family. The hospital may not have been able to save his life in the long run; however, they certainly could have given him a better, fighting chance, initiated life-saving treatment, and more assertively connected him to outpatient care. Situations like this happen everywhere, every day, and they need not. We can do better, and we should.