Tags: patient safety , redesigning care , community partnerships

Addiction is a complex issue that touches every aspect of the communities we serve. At Partners, we also understand that the traditional treatment models, which considered addiction an acute disease, were too often ineffective.

This is why we’re so proud to see that the Substance Use Disorder Strategic Initiative, launched in 2014 by Massachusetts General Hospital, is having such a profound, demonstrable impact on the patients, families and communities it serves.

To date, the Initiative has illuminated the standard treatment plan for addiction, moving it from an ineffective model of episodic treatment to an evidence-based, chronic disease management system of care. Dr. Martha Kane, MGH Clinical Director, West End Clinic Addiction Services, sees this as fundamentally restructuring the care model to match what we now know from science about addiction.

“Despite the evidence that addiction is a treatable, chronic disease like hypertension our treatment models have often been acute and episodic,” she said. “We have been great at treating the medical complications of addiction or even detoxifying a patient but often the underlying disease goes untreated.”

"Despite the evidence that addiction is a treatable, chronic disease like hypertension our treatment models have often been acute and episodic. We have been great at treating the medical complications of addiction or even detoxifying a patient but often the underlying disease goes untreated."

When that’s the case, costs understandably skyrocket. Dr. Kane explained that when we compare the treatment costs of an addict to a patient with a chronic condition, such as diabetes, the costs of addiction are astronomically higher. “The recidivism rates we were seeing were very high because of course we weren’t really treating the addiction at all,” Dr. Kane said.

As a result of the initiative, Dr. Kane confirms that attitudes are indeed changing. Doctors feel there is structure beneath them now that a comprehensive continuum of care exists. It begins with acute stabilization and engagement in the hospital by an addiction consult team; then transitions to longitudinal care in the community within our health centers and with “recovery coaches” (i.e., peers in recovery with a unique connection to addiction); and finally, to a Post-Discharge clinic for transitional addiction treatment following a discharge from the inpatient setting.

“The critical part of this initiative is the recovery coach,” Dr. Kane said. “The difference they make lies in their fluidity—they essentially follow a patient wherever they go throughout the system. Their goal is reduce barriers to treatment, and to form personal connections.”

Since inception, recovery coaches have had a measurable impact: Of the 300 patients who have been connected with a coach, 57% self-report a decrease in ER admissions and 67% experienced an increase in days abstinent.

"The critical part of this initiative is the recovery coach. The difference they make lies in their fluidity—they essentially follow a patient wherever they go throughout the system. Their goal is reduce barriers to treatment, and to form personal connections."

“And this progress has all built on itself as we’ve added more patients month after month, Dr. Kane said. “What was once an eight-floor, in-patient setting will be, by the end of 2016, hospital wide.”

Additional investment and openness to medication-assisted addiction treatment (e.g., suboxone and VIVITROL) has produced a drop-in clinic for patients who would not be receiving care under the traditional addiction treatment model. In this clinic, Dr. Kane said, patients who do not have the ability to schedule and make an appointment can show up when they feel like it.

“These are patients who may be high when they come in. This kind of clinic doesn’t exist anywhere else in city, but already two other major hospitals—Brigham and Women’s (also a Partners hospital) and Boston Medical Center—have approached us, and we are hopeful they will build the service as well,” she said.

Dr. Kane says the Initiative will continue to push hard to get staff certified for medicine-assisted treatment, to ensure the momentum continues. There is also a new task force that is responsible for expanding these addiction treatment services to patients 18 years and under, including a prevention group that will work to catch addiction earlier for better outcomes. A second task force is investigating how treatment models can be extended to prenatal care.

As more hospitals and health care organizations see the success of the approach laid out at MGH, we can only hope this progress continues to extend to other communities throughout our region, and beyond.

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