The MGH Substance Use Disorder Initiative Sarah E. Wakeman, MD, FASAM Medical Director Assistant Professor of Medicine, Harvard Medical School

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1 The MGH Substance Use Disorder Initiative Sarah E. Wakeman, MD, FASAM Medical Director Assistant Professor of Medicine, Harvard Medical School

2 Disclosures Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.

3 3

4 Addiction #1 Community Priority

5 Addiction #1 MGH Priority

6 Comprehensive Approach Across All Settings

7 SUDs Initiative Goals Original mission/vision: The 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. To accomplish this mission, patients must have access to evidence based treatment that is readily available and standardized across the system. Goals 1. Improve the lives of our patients 2. Create systems that allow us to do #1

8 Comprehensive Approach Recovery Coaches Inpatient (ACT) Bridge Clinic Outpatient Community Prevention, Education & Evaluation

9 Inpatient: Addiction Consult Team Specialized multidisciplinary approach MDs (med/psych), NPs, LICSWs, Clinical pharmacist, resource specialist, trainees Hospital admission is a reachable moment Systematic screening (RN-based AUDIT-C/NIDA-1) Motivational enhancements/engagement Pharmacotherapy Initiation Linkage to treatment

10 Inpatient: Addiction Consult Team ACT Consults: Available across entire hospital consults ~64% alcohol use disorder, 28% opioid use disorder Patients seen by ACT show significant decrease in severity of drug use & increase in abstinence 30 days post-hospitalization

11 Percent of Encounters Percent of Encounters Patients seen by ACT more likely to be discharged with pharmacotherapy Pharmacotherapy - Discharge Rx* SUDs Patients on ACT Floors 100% 90% 92% 85% 88% 80% 70% 60% 50% 40% 30% 20% 10% 6% 6% 4% 4% 4% 5% 0% Jul-14 Aug-14 Sep-14 Naltrexone Methadone Buphrenorphine Acamprosate Disulfiram Naloxone None ACT Patients During Consult Admission 60% 50% 48% 43% 40% 30% 29% 28% 21% 20% 18% 18% 15% 16% 12% 12% 12% 12% 9% 9% 10% 10% 6% 7% 2% 0% Jul-15 Aug-15 Sep-15 Naltrexone Methadone Buprenorphine Acamprosate Disulfiram Naloxone None *"None" includes all pharmacotherapy excluding those medications specifically analyzed

12 Bridge Clinic: Transitions from Inpatient & ED and Connection to Community Care Opened February 2016 Addiction Medicine Physician, Psych NP, Resource Specialist, Recovery Coach, Clinical Pharmacist Provides pharmacotherapy, peer support services, referral & linkage to outside treatment services Bridge clinic-ed Pilot: patients with opioid use disorder who are medically cleared brought directly to the Bridge Clinic to begin treatment

13 Bridge Clinic Snapshot April-November: 196 patients seen 151 seen more than once Number of visits: 1 visit: 23% 2-4 visits: 31% 5-9 visits: 22% 10+ visits: 25% Median number of days followed in Bridge clinic= 69 days Median number of days between visits= 7 84% of patients have had a same day visit and 68% have had a walk-in visit

14 Outpatient: Transforming Care People do not fail treatment, treatment fails people Multi-disciplinary teams of SUD champions Increased access to pharmacotherapy & counseling Twice monthly risk rounds Recovery Coaches Collaboration with communitybased treatment providers 14

15 Recovery Coaches 8 coaches 813 patients touched 7557 coach contacts 4,610 hours of contact Total caseload ranges Active caseload Patients report they improve patient experience, facilitate access to social services, and provide ongoing social support

16 Community Partnerships Opioid treatment programs Direct methadone transfer Residential treatment and IOP Post-acute care Skilled nursing facilities collaboration

17 Changing Culture, Changing Care If I were anywhere else I would have relapsed by now but I feel very supported here by the addiction team and the medical team. I don't feel stigmatized." Physicians who had a patient receive care from the initiative: Find caring for patients with SUD more satisfying Have less negative attitudes towards SUD Feel more prepared to diagnose and treat SUD More likely to prescribe pharmacotherapy, naloxone, and provide addiction treatment themselves

18 Future Directions 18

19 Thank The MGH SUD Initiative Team And many others!