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April 27, 2018

How Geisinger, Boston Medical Center, and more are implementing the 'gold standard' for opioid use disorder

Daily Briefing

    By Gillian Michaelson, Consultant

    The opioid epidemic sweeping the United States and has seeped into communities across the country, affecting payers and providers in every state. And while it will take time and resource coordination to truly curb the current crisis, there is a proven, gold standard treatment for opioid use disorder that hospitals and health systems can deploy now: medication-assisted treatment (MAT).

    Keep reading to learn more, and be sure to register for our webconference on Monday, April 30 to learn how to think about the status of the opioid crisis in your region, the key performance metrics you should use to prioritize your opioid-intervention strategy, and more.

    Register Now

    Why medication-assisted treatment is the gold standard of care

    Medication-assisted treatment refers to the use of medications to help treat opioid use disorder. It is frequently paired with a non-pharmacological treatment, such as behavioral and physical therapy

    There has been some historic debate around MAT's efficacy, with some industry experts raising concerns about dependence. For instance, when asked about MAT former HHS Secretary Tom Price last year said, "If we're just substituting one opioid for another, we're not moving the dial much." But the medical and scientific communities have seen a shift in the way MAT is viewed.

    That shift became most evident, last September when FDA Commissioner Scott Gottlieb enthusiastically endorsed MAT use: "MAT … is one of the major pillars of the federal response to the opioid epidemic. ... This type of treatment is an important tool that has the potential to help millions of Americans with an opioid use disorder regain control over their lives."

    There are currently three methods of FDA-approved, MAT delivery: methadone via regulated methadone clinics; buprenorphine, which is delivered in office-based practices by providers who have completed an eight-hour training; and naltrexone, which is offered in the form of a monthly injection (and does not require a provider to have a waiver, meaning it can be prescribed by any clinician with prescribing authority).

    These medications don't impair individuals' ability to function, but they do address the withdrawal symptoms, such as severe nausea and full-body aches, that so frequently lead to relapse. As such, research has shown MAT reduces the risk of relapse.

    What's more, studies have shown that MAT reduces the risk of patient mortality when compared with other treatments, helps prevent the spread of infectious diseases, like HIV, and can lower overall annual health plan costs by 29%, when compared with those whose treatment does not include medication.

    As Michael Botticelli, executive director of Boston Medical Center's Grayken Center for Addiction Medicine said, "Medication-assisted treatment saves lives while increasing the chance a person will remain in treatment and learn the skills and build the networks necessary for long-term recovery."

    Although the scientific community supports the use of MAT, there is still certainly room for additional research in this space. This includes further analysis to determine the characteristics of the most effective form of MAT and strategies to best reduce stigma against MAT, and opioid use disorder generally, in local communities.

    How 3 leading health systems are supporting MATs

    Hospitals and health systems are positioned to lead the charge against opioid use disorder by increasing access to MAT. Executives can play a key role by empowering leaders to identify the most effective clinical components of addiction treatment and develop ED triage protocols for opioid use disorder patients.

    In particular, health systems can use hospitalizations as opportunities to start patients on MAT. For instance, Oregon Health & Science University implemented the Improving Addiction Care Team (IMPACT) model to get inpatients into treatment faster. From July 2015 to September 2017, 521 out of 600 patients engaged with the new model. Sixty-one percent of those patients began treatment during their hospital stay, and 68% were referred to treatment within the community post-discharge.

    Health systems also should look beyond the hospital walls to integrate MAT strategies in outpatient facilities. Geisinger Health System, for instance, trained pharmacists embedded in primary care clinics on alternatives to pain management and on identifying patients at risk for addiction. After 12 months, the health system saw ED visits decline by 20% among the patients being seen by the trained pharmacists. 

    Finally, health systems can find partners in local communities to help increase access to MAT. Boston Medical Center partnered with the Massachusetts Department of Public Health, for example, to create an opioid urgent care clinic. The clinic's location allows providers at Boston Medical Center to directly refer patients to the clinic, while giving clinic staff access to the hospital's resources if needed for acute care.

    Fortunately, recent data suggest the tide of the opioid crisis may be changing: the number of opioid prescriptions fell by 10% in 2017, while the number of newly prescribed MAT has nearly doubled over the past two years. Health systems and hospitals can continue to drive that change.

    Next, join us to learn how to develop a comprehensive opioid strategy

    Join us on Monday, April 30 for a webconference where you'll learn how to think about the status of the opioid crisis in your specific region, the key performance metrics you should use to prioritize your opioid-intervention strategy, and more.

    Register Now

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