Posts Tagged ‘buprenorphine in hospitalized patients’

Something Great Happened Today

 

 

 

 

Today we admitted a young man to our opioid treatment program who was referred from a Big City Hospital, where he was started on buprenorphine/naloxone. Everything happened exactly like it should, and the patient got excellent care. This should happen everywhere.

This patient went to the emergency department at Big City Hospital at the urging of his family, who recently discovered he had opioid use disorder. They were worried about him and convinced him to seek help at the hospital close to them, BCH.

Big City Hospital admitted him for detoxification and started him on a low dose of a buprenorphine product. Over the four days that they kept him, they slowly increased his dosage to a total of 8mg per day. At that dose, his withdrawal symptoms resolved, and he had no cravings to use illicit opioids. BCH also drew blood from him, and he tested negative for infectious diseases and other medical problems.

Once he was stable, the social worker at Big City Hospital needed to find a program or provider  his community that could take over his care. As it happened, he wanted to move away from where he’d been living. He feared his friends, with whom he’d using drugs, could lead him to relapse back to drug use. He decided to move in with some supportive relatives, who happen to live near our opioid treatment program. The social worker called our program and arranged an appointment for admission for the day after he was to leave BCH.

BCH gave him a dose the afternoon he was discharged from their hospital, and he kept his appointment with our program early the next morning. He was just starting to feel a little withdrawal from his last dose of buprenorphine. Big City Hospital had already faxed his records to us, so those were available for me to review.

He was a nice young man from a good family who had fallen, as so many have, into opioid use disorder before he knew what was happening. He had a strong desire to change his life and leave his addiction behind. We continued his dose of buprenorphine products, and started intensive counseling right away.

I’m so happy that appropriate treatment was offered to this young man at the time he reached out for help. He was admitted, started on treatment and then transferred to us without any gap in treatment. A successful inpatient treatment episode flowed seamlessly into our outpatient program, without relapse and without the patient being forced back into withdrawal.

All worked as it should. It’s not that hard.

So how can a large hospital nearly a hundred miles away refer a patient to us but we don’t get referrals from our local hospital a few miles away?

My answer is that though our local hospital is close in miles, it’s far away in its ideology about the role of buprenorphine and methadone in the treatment of patients with opioid use disorder.

However, there’s reason to hope that this is changing.

A few weeks ago, I was asked to come to the hospital to give a presentation of opioid use disorder and its treatment with medication for nursing personnel. I was thrilled. Our program director and clinical director were thrilled. We scheduled a “Lunch ‘N Learn” for noon, with the hospital graciously furnishing the food.

I was surprised and pleased when a room full of people showed up for my talk. The head of pharmacy was there, who has always supported MAT, with a few pharmacy students. None of the staff nurses were there, but nursing supervisors were, and some people from our local mental health agency, who just got a grant to care for pregnant ladies on MAT. We had the director of the local health department, who has always been supportive, and many other people. Two doctors and at least two physician assistants were there too.

I gave my usual 50-minute presentation, and the audience asked great questions when I was done. Then, to drive the message home, we had a former patient tell her story of life on methadone, off methadone, and now back on methadone. She has that gift of speaking from the heart, and I think she helped inform audience members more than anything I could have said.

I wanted to get copies of TIP 63 to pass out to all people in the audience, but it was bad timing – TIP 63 wasn’t available because it’s being re-done. I like to give people TIP 63 because when they challenge me on this point or that, it contains all the pertinent studies supporting what I say about MAT.

One audience member appeared to disapprove of starting pregnant patients with opioid use disorder on methadone or buprenorphine. She claimed that all babies born to moms taking these medications had withdrawal when born, and that the withdrawal lasts for many months. I tried to describe the results of the MOTHER trial, done right here in North Carolina, since it was one of the most recent landmark studies.  It showed that around 50% of babies born to moms on buprenorphine or methadone have withdrawal bad enough to need medication, and that babies born to moms on buprenorphine had much less severe withdrawal and stayed in the hospital about half as long as babies born to moms on methadone.

I did not get through to her. I sensed she relied much more on her own perceptions and experiences than on data from research studies done on hundreds of patients.

Despite that disagreement, I thought the event was a great success.

Now we are asking to come back and do another presentation for the staff nurses.

We’ll keep trying. Someday I hope to see a local patient who arrives in our local hospital’s emergency department, gets diagnosed with opioid use disorder, is treated in a respectful and compassionate way, gets started on buprenorphine and then gets referred to our opioid treatment program (or other MAT program) right away.

I’d like to see a Big City response to our rural crisis.