Hospitals across the country are working to curb the health crisis that is opioid use, addiction and overdose.
But battling the growing national epidemic means more than just treating drug users when they overdose, according to officials with area hospitals and health networks. It means combating it with community outreach and education and becoming more responsive in providing long-term rehabilitation and recovery options.
However, the heroin and opioid epidemic is a much larger entity than any one hospital or health system could dream of tackling on its own, according to Dr. Marcus Romanello, chief medical officer at Fort Hamilton Hospital in Hamilton.
“It’s going to require a multi-pronged approach from other civic and community entities as we … attempt to make a dent in it,” said Romanello, who has been working at Fort Hamilton’s emergency department for more than five years. “I’ve definitely seen an increase in the number of overdoses that come into the emergency department.”
When he started at the hospital, overdoses numbered about two on the weekend, he said. Now, it is a daily occurrence.
“They average one or two per day and then on the weekend, as high as four or five, where someone was unresponsive in the field, the EMS personnel administered Narcan to awaken them and then they were brought to the emergency department for further assessment,” Romanello said.
Fort Hamilton Hospital patients who are recognized as having an addiction are provided resources ranging from where they can find outpatients management and counseling to opiate replacement therapy and psychiatric care, he said.
While patients do arrive at hospitals asking for detox, that service is considered an outpatient condition and one that medical personnel can refer to via outside services.
Fort’s Opiate Recovery Taskforce (F.O.R.T.) Golden Ticket program, a measure initiated at the hospital two years ago, includes a quick response team that heads out into the community to combat the opiate drug epidemic, according to Jennifer Mason, EMS coordinator for Fort Hamilton Hospital.
“Our mission is to reduce the stigma of addiction, but with that we have a team of law enforcement and a substance abuse counselor and we take referrals of overdoses or those struggling with opiate addiction that want help,” Mason said. “They clearly have to identify that they want help, not a family member wanting help for them.”
Referrals to the program can come from physicians, nurses, EMS workers and law enforcement. Sometimes the team announces when it is coming to visit an individual and sometimes it just shows up, she said.
“Whatever we feel is going to work is best for that person,” Mason said.
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The team can then assess an addicts situation and make recommendations for recovery, partnering them with the appropriate facility for their situation, sometimes even in the same day. Even if an addict decides to not complete his or her program, the quick response team’s visit may end up planting the seeds that may begin to nurture a decision to seek treatment later on, Mason said.
Fort Hamilton Hospital also works in partnership with community resources, including the Butler County Mental Health and Addiction Recovery Services Board, to ensure the hospital can “bring about change and help bring a greater awareness to these issues,” according to Michael Mewhirter, the hospital’s president.
Atrium Medical Center has “definitely seen an increase” in the amount of overdoses it is seeing, according to Tina Gregory, Atrium’s director of emergency and behavioral health services.
“Three years ago, you would go days, maybe, without seeing an overdose, now we see usually around four a day,” Gregory said. “We’ve had days in a 24-hour period where we’ve had as many as 14. We’ve had some days (where) we see one or two.”
Sometimes the hospital sees the same patient twice in a 24-hour period, she said.
Besides using Narcan to help revive patients who are in the midst of an overdose as they are brought to a hospital by a friend or relative, Atrium Medical Center also works with social workers to assess those patients and try to connect them with community resources, Gregory said. That way, patients learn what help is available to them, she said.
In addition, an ER physician may prescribe a Narcan kit to the patient so he or she may leave with the means of preventing any possible future overdose from turning fatal.
Atrium is in the process of collaborating with several different agencies to develop a more proactive approach where it does not have to rely on a patient to make a connection with a community resource.
“We will get consent from the patient to give their phone number and name and their presenting complaint to the community resource, where they in turn reach out to try and connect with the patient,” Gregory said.
Michael Uhl, president, Atrium Medical Center, said combating the problem doesn’t stop with emergency treatment.
“It’s connecting to resources before things happened and taking the lead of being a health care system and helping to drive and initiate some new measures in the community,” Uhl said.
To that extent, Atrium Medical Center is “heavily involved” in the Middletown Heroin Summit, which holds its meetings at the hospital.
Tom Parker, chief experience officer for Premier Health, said the network is working to reduce, slow and eliminate the overdose epidemic created by heroin, opioid and fentanyl abuse by fostering opportunities.
Doing so, he said, requires “deeper, broader and wider” collaboration efforts and developing partnerships with organizations and system’s agencies in each of Premier’s marketplaces.
“Everyone is in this fight together,” Parker said. “This is a time for systems to come together and find the commonness in what they’re doing to improve the overall health of their communities. This is not a time for … concerns around competition for various players in the health care marketplace.”
To reduce overdoses, Premier Health is looking at physicians’ prescribing patterns to ensure they are utilizing the best practice standards that are established nationally so the hospitals do no perpetuate an issue of creating persons who are addicted to pain medicine, particularly opioids.
Recent numbers at Mercy Health-Fairfield Hospital illustrate just how much the heroin crisis has worsened in the past year alone.
From January 2016 through May 2016, the hospital saw 84 heroin suspected overdoses. The same time span in 2017 saw the hospital treating 157 suspected heroin overdoses, according to hospital data.
Overdoses number between none and about 2 to 3 a day in a typical week, averaging 1.03 heroin overdoses per day, hospital officials said. The highest number of overdoses in 24 hours was 7.
Mike Garfield, CEO and senior vice president of Mercy Health-Cincinnati, said the health system is actively helping treat patients affected by opiate addiction by providing medically-assisted detoxification, behavioral health support and warm patient hand offs to partner agencies offering national standard levels of care for long-term rehabilitation.
Mercy offers voluntary inpatient detox at Mercy Health-Clermont Hospital and pairs it with “a seamless and timely” patient hand off to community providers who offer the next level of longer-term treatment to help prevent fatalities associated with relapse, an all-too-common occurrence, Garfield said.
“We have started to talk and meet with partners in Hamilton, the opiate epicenter in Butler County, to determine how we an work together address the crisis locally,” Garfield said. “With the will of the community, we can replicate the Clermont County program in other Ohio counties, including Butler County.”
Such a program would include robust behavioral therapy as part of the recovery and a lifelong management process in order to reduce the number of patients overdosing and undergoing MAT repeatedly, he said. In addition, it would involve agency partners who can provide long-term outpatient addiction treatment, transitional housing, drug-free treatment centers and sober living environments.
Through a grant-funded program, Mercy Health Foundation and Mercy Health’s Behavioral Health Institute are making it possible for all Mercy Health emergency departments – including the emergency department at Fairfield Hospital - to screen adult patients by the end of 2018.
Additionally, Mercy Health-Cincinnati is working to grow prevention efforts by developing and supporting comprehensive community education and awareness programs and scaling them across the region and engaging actively in shaping the community response to the opiate crisis.
Mercy Health also is training its staff psychiatrists, physicians and nurses in addiction medicine.
“Ultimately, we will have primary care physicians, emergency physicians and hospitalists undergo training in addiction medicine and care delivery,” Garfield said.
WEST CHESTER TWP.
As a member of UC Health’s Academic Health System, West Chester Hospital is a member of UC Health’s Opioid task force which uses the breadth and depth of the system’s resources to combat the opioid epidemic, according to Dr. Elizabeth Leenellett, medical director of the emergency department at UC Health West Chester Hospital and an associate professor of emergency medicine.
“We also work in tandem with our community partners to provide education on prevention and treatment options for those suffering from addiction and for their families,” Leenellett said.
The hospital will, on average, see two or three overdose victims a week.
“On a particularly busy day, we could see as many as four, but that is a rare occurrence,” she said.
Making matters worse is the recent increased usage of fentanyl, either mixed with heroine or used on its own, Leenellett said.
“There has also been a marked increase in overdoses involving use of carfentanil, an extremely potent, dangerous substance which can also be absorbed through the skin through unintended contact,” she said.
West Chester Hospital works with area law enforcement, EMS, fire departments, and other first responders to facilitate education, training, and outreach around the topic of opioid addiction and recovery, Leenellett said.
“Our team at West Chester Hospital has also partnered with local high schools to provide prevention and outreach programs, as well as Miami University,” she said. “Our partners at the Lindner Center for HOPE, Beckett Springs, and other facilities providing rehabilitations also look to our clinicians for information and education around the subject.”