For many people, addiction begins in the doctor’s office. University of Maryland Medical Center (UMMC) Opioid Stewardship Task Force was established in 2017 with this in mind. One of the task force’s top priorities is to educate physicians on how to responsibly prescribe opiates.
“We produce a monthly report that shows providers what medications they’re prescribing,” Christopher J. Welsh, MD, associate professor of psychiatry at the University of Maryland School of Medicine (UM SOM) and medical director of Outpatient Addiction Treatment Services said. ”If someone utilizes opiates more than their colleagues, we address their prescribing practices and work to cut down on their opiate prescribing.”
The task force has also created processes within the emergency department (ED) at both campuses to address opioid abuse.
“We screen all ED patients for their risk of opioid abuse disorder,” Janine L. Good, MD, associate professor of neurology at the UM SOM and chief medical officer at UMMC Midtown Campus, who established the task force, said. “If they come into the ED with an opioid overdose, we engage a trained ‘peer recovery coach’ to intervene and guide them to treatment. These are people in recovery themselves who engage with patients in the ED and, based on the patient’s risk, encourage them to enter a treatment program.”
The peer recovery program has seen great success. By December, UMMC’s campuses had referred 4,480 patients to treatment.
The pipeline from the ED to treatment engages patients when they need help the most. Unlike many other U.S. hospitals, UMMC’s doctors can prescribe buprenorphine in the ED. The task force also makes an effort to influence state policy.
“We are at the table advocating on behalf of the complex pain patients we treat at our hospitals and on behalf of our doctors caring for patients,” Dr. Good said.
Additionally, the task force collaborated with the Baltimore City Health Department’s formation of a ranking system to measure each hospital’s capability and resources to combat the opioid epidemic. UMMC’s campuses are the only two hospitals in the city that were awarded top ranking.
“We are leaders in the state for dealing with opioids,” Dr. Welsh said.
A Medical Approach to Addiction
Maryland has one of the five highest opioid-related death rates in the United States. Despite this, the stigma surrounding addiction continues to be an obstacle to treatment.
“People are ashamed,” Eric Weintraub, MD, associate professor of psychiatry and director of the division of addiction research and treatment at the UM SOM, said. “Sometimes they refuse evidence-based treatments because they are pressured by people in their lives to avoid taking medications that can help.”
Photo: Dr. Weintraub and Dr. Welsh
To combat this stigma, UMMC offers addiction treatment centers that take a medical approach. A combination of counseling, detoxing or taking medications that curb opioid cravings helps patients recover.
“The medical model that we follow affords more respect for our patients’ medical issues and diminishes the stigma,” Marian Currens, CRNP, director of UM CAM, said.
Each clinic works to treat the entire patient, not just the addiction. Aside from counseling services, some clinics offer additional health services. One clinic partners with the Institute of Human Virology to treat infectious diseases such as hepatitis C and HIV, which are more common among people with an addiction disorder. They have recently expanded the practice to offer primary care services. They also established a drop-in center that provides a safe place for clients to relax with snacks and games.
Another UMMC clinic focuses on female patients and pregnant women with opioid use disorders.
“The clinic has a play center where women can leave their children while they’re in counseling. It removes a barrier to treatment,” Dr. Welsh said.
Public awareness is essential for fighting the opioid epidemic. UMMC’s Community Health Improvement Team fulfills this need by circulating information about opioids at community events throughout West Baltimore.
“We have a handout that helps the general community understand the types of drugs that are out there, how they can identify if their loved one has an addiction problem and where they can go for help,” Anne D. Williams, DNP, director of community health improvement, said. “One of the main things people can do to get drugs off the street is to remove old medications from their homes and dispose of them appropriately.”
To facilitate this, the team provides information about drug take-back locations across Maryland. UMMC pharmacies have their own drug take-back bins.
“This problem has so many facets, and the community should take this seriously,” Williams said. “They should try to get themselves or their loved ones help. Dispose of your medications properly, and if you’re actively using pain medications, make sure they are locked up.”
“This is a deadly epidemic. It cuts across all segments of society,” Dr. Weintraub said.
We all need to pull together to combat this disease.”
UM Charles Regional Medical Center’s Response
Ever since Gov. Larry Hogan signed the Heroin and Opioid Prevention Effort (HOPE) and Treatment Act into law in 2017, University of Maryland Charles Regional Medical Center (UM CRMC) and the Charles County Department of Health have been partnering to reduce the opioid epidemic.
When patients experiencing an opioid overdose go to the emergency room, they have the opportunity to talk with a peer recovery specialist — someone who has been in their shoes but conquered their addiction.
“It’s very useful to have somebody that understands the issue of opiate addiction spend time with these patients after they go through an overdose. It’s a critical time to intervene,” Richard Ferraro, MD, chief of medical sta at UM CRMC and chairman and medical director of the Department of Emergency Medicine, said.
Patients also receive a prescription for the opiate-reversing drug naloxone and instructions for using it. In addition, UM CRMC has focused on improving its approach to pain management and reducing prescriptions for opiates.
“Our providers follow strict opiate prescribing guidelines and explore alternatives to opiates when appropriate,” Debbie Shuck-Reynolds, MSN, nurse manager of the Department of Emergency Medicine at UM CRMC said. “Pain is real and we want to manage it, but we want to do it safely.”
These efforts are paying off. Opiate-related deaths in Charles County dropped from 36 in 2016 to 13 in 2018.
“There’s been a tremendous effort in combating this, and we’ve seen a drop in the number of overdoses,” Sara Haina, director of substance abuse services for Charles County, said.
If you or a family member is struggling with addiction, reach out, Shuck-Reynolds advised.
“We can get you the help you need,” she said.
If you or a loved one has an opioid addiction, please call:
- UM Center for Addiction Medicine: 410-225-8240
- UMMC’s Outpatient Addiction Treatment Services: 410-328-6600
- UMMC’s Women’s Mental Health Program: 410-328-6091.
This story first appeared in the spring issue of Maryland’s Health Matters, the quarterly magazine of the University of Maryland Medical System and University of Maryland Charles Regional Medical Center. To read the full story — and explore other regional editions — by visiting our website.