Tuesday, June 16, 2015

Mass General’s Response to the Opioid Epidemic

Mass General Hospital is on the front lines of the opioid epidemic. In October 2014, as a result of a community health needs assessment, Mass General developed a new approach to the treatment of substance use disorders, including opioid use disorders, the highest clinical priority of a hospital-wide strategic plan.  The MGH Substance Use Disorders (SUDs) program goal is to have substance use disorders addressed along all levels of health impact; from primary community-based prevention to early intervention and treatment to chronic disease management.

The SUDs initiative builds on the long-standing clinical addictions treatment at MGH through West End House and Addiction Recovery Management Service (ARMS).  A collaborative effort between the MGH Department of Medicine, Department of Psychiatry, Patient Care Services, The Center for Community Health Improvement, and MGH Community Health Centers, this initiative was designed to improve the quality, clinical outcomes and value of addiction treatment for all MGH patients with SUD while simultaneously reducing the cost of their care.

Patient must have access to readily available patient-centered treatment that is standardized across the system to control costs and designed for maximum effectiveness. The MGH SUDs initiative is focused on re-designing care at all levels to meet this goal.

Key Initiative Components

  • Inpatient – Creation of a multidisciplinary consult team which provides patients who are hospitalized with comprehensive evaluation, treatment recommendations, and links to hospital and community resources. 
  • Bridge Clinic – A transitional outpatient clinic providing short term medical and psychiatric care for discharged inpatients and patients leaving the Emergency Department who are not yet connected to outpatient care but are in need of continued treatment for their SUD until appropriate community linkages can be made.
  • Recovery Coaches – Peers in recovery themselves who assist patients in their process of achieving recovery by helping them overcome barriers to treatment, providing motivational support, and serving as key members of the patients’ care teams.
  • Enhanced Health Center Treatment – Each of the MGH Community Health Centers of Charlestown, Chelsea, and Revere redesigned care to increase access to evidence-based treatment, including pharmacotherapy and readiness services, and to integrate mental health and primary care around the treatment of this disease. 
  • Opioid Prescribing Policies – New guidelines for safer chronic opioid prescribing designed and implemented across all of our primary care practices including undertaking an inventory of inpatient opioid prescribing policies across the institution with the goal of developing a standardized, hospital-wide policy.  
  • Education – Enhanced utilization and understanding of a validated SUD screening for all inpatients upon admission. Continuing to develop broad-based education curriculum to strengthen understanding & treatment of SUD within the internal MGH community, in the medical community and in the public.
  • Research & Evaluation – Conducting clinical research and ongoing evaluation of this comprehensive and integrated approach to treating patients with SUDs and using the results to guide treatment standards here at MGH and hopefully beyond.
  • Culture Change – Utilizing all opportunities to inspire hope and motivation in caring for this patient population by helping shift away from the historical conception of SUD as a choice to recognition and understanding that SUD is a chronic, and more importantly, treatable disease.

 

The MGH Substance Use Disorders initiative builds on years of community-based prevention partnerships, particularly in Chelsea, Revere and Charlestown, home to Mass General’s health centers.  Through the Center for Community Health Improvement, MGH supports three multi-sector coalitions that seek to prevent and reduce substance use through education, prevention, policy change and intervention strategies in these neighborhoods.  We provide staff, best practices, evaluation support and access to a range of additional resources. For these efforts, we have been awarded national recognition for reducing key indicators of teen alcohol use in Revere.   Examples of the coalitions’ work include:

Social Marketing to Change Community Norms

  • Revere CARES launched its first social marketing campaign known as the ‘Power of Know’ in 2003.  Each year has a different focus and more than 800 parents sign a pledge at back to school night that they will talk to their children, this year about the dangers of abusing prescription drugs. 

Education

  • Since 2006, the Charlestown Substance Abuse Coalition has provided Botvin LifeSkills Training, a curriculum proven to reduce the risks of alcohol, tobacco, drug use, and violence, to 450 5-8 graders, at public schools and the Boys and Girls Club in Charlestown each year. 

Policy

  • Revere youth and adults successfully advocated for tobacco free public spaces more than a decade ago, and for limits to liquor licenses in convenience stores.

Harm Reduction

  • Coalitions sponsor Prescription Drug Take Back events that help to remove medications from homes, often the first place that teens find medications to experiment with and work with others to distribute naloxone (Narcan), which reverses opioid overdoses, throughout the communities. 

Fighting Stigma in the Community

  • Annual events such as Revere’s Community Walk for Recovery and Beach Memorial and Charlestown’s Candlelight Vigil are designed to fight stigma and to support families who have lost a loved one to addiction.

 

 

 

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