As America’s opioid crisis worsens, the number of patients with addiction issues presenting at University of Alabama at Birmingham Hospital continues to grow. Some arrive at the emergency department in the active throes of overdose or withdrawal. Others are pregnant. Some have infections from unclean injection sites or have slipped into addiction from using prescription opioids for chronic pain.
Medical staff in virtually every unit of the hospital can, at some point, expect to find themselves treating patients who are abusing opioids.
“Staff in some areas of the hospital such as our Addiction Recovery Unit are well-versed in dealing with patients with opioid issues, but the sheer size of the current epidemic means every health care professional needs to be prepared to care for patients with opioid addiction,” said Jordan DeMoss, senior associate vice president of UAB Hospital.
The hospital has kicked off a new program to give health care providers training and insight on opioid addiction called the Addiction Scholars Program. Modeled after the hospital’s successful Geriatrics Scholars Program, the initiative has recruited 25 hospital staff — physicians, nurses, therapists, social workers and more — who will undergo a 15-month curriculum taught by UAB experts in addiction medicine.
“The goal is to better prepare staff for the challenges facing patients with opioid addiction and to find better ways to provide the appropriate care to this patient population,” DeMoss said. “To our knowledge, this is the first such effort in the nation to address this issue in this way.”
|“The goal is to better prepare staff for the challenges facing patients with opioid addiction and to find better ways to provide the appropriate care to this patient population. To our knowledge, this is the first such effort in the nation to address this issue in this way.”|
“Most physicians don’t receive formal training in addiction management,” said Eddie Mathews, M.D., a hospitalist and one of the first 25 scholars. “Yet there is a clear need for enhanced education for all medical professionals. We need to learn about the disease process in addiction and learn how we can better treat these patients, both for their opioid use and for any underlying or concurrent medical issues.”
The first class of scholars began with an intense two-day workshop on addiction, followed by monthly meetings to examine additional topics in greater detail.
“There are a lot of misconceptions about opioids,” said James Weisberg, Ph.D., an associate professor in anesthesiology who is a pain psychologist and one of the scholars. “This is a disease, not a character flaw, and this program will help to communicate to hospital personnel a better understanding of what is involved in addiction.”
The scholars are working on five projects designed to improve care that will be incorporated into usual hospital practice. One is centered in the emergency department, looking at ways to provide linkage to continued care for patients seen for overdose or withdrawal.
“We see a lot of patients on opioids at the emergency department, and we thought that linking those people to appropriate care after their immediate medical needs are met is essential,” said Tamicka Jones, R.N., one of the scholars. “We’re compiling information on resources, training emergency department staff and making connections in the community so we can help refer people to the kinds of programs or organizations that may be able to provide them with needed help.”
Another project focuses on enhanced education for patients while they are admitted.
|“We treat the infection, but must do a better job of treating the underlying addiction issues, and that starts with affirming that addiction is an illness, not a weakness. We need to stress to patients that addiction in not a matter of will, or lack of it, and that they need to seek medical care for their disease.”|
“I see a lot of patients who are hospitalized due to infection caused by unclean needle use,” Mathews said. “We treat the infection, but must do a better job of treating the underlying addiction issues, and that starts with affirming that addiction is an illness, not a weakness. We need to stress to patients that addiction in not a matter of will, or lack of it, and that they need to seek medical care for their disease.”
This project will prepare educational materials that ultimately can be shared with all patients at the hospital, not just those at increased risk or with active addiction.
A third project is housed in UAB’s Women and Infants Center, to provide early identification of pregnant women in need of addiction services. The program is looking at ways to screen for potential opioid use and link those women to specialized care.
Another project will make naloxone kits available at discharge for patients with opioid issues. Naloxone is a medication that can reverse the effects of opioid overdose if delivered within an appropriate time frame. Kits, and training in how to properly use them, will be provided to patients with a known opioid history or to family members.
Staff education is the final project. The scholars will create materials for hospital staff across the board and disseminate those materials through the usual communication channels available to hospital employees.
“This is such a comprehensive disease and is so pervasive in our society now,” Weisberg said. “The pendulum of opioid use has swung back and forth many times in the past. This might be the most dramatic swing we’ve seen.”
The current class of addiction scholars will complete their work next summer, and UAB will enroll another class to continue the initiative.