Rhode Island supported the development of Behavioral Health Link, BH Link, a 24-7 urgent care program for addiction and mental illness. The goal is to divert patients from less effective, more expensive emergency room visits to an urgent care visit which would directly provide care. And CODAC Behavioral Healthcare, an opioid treatment program (OTP) with 8 facilities is based in Cranston and has the contract to participate with a Community Mental Health Center (CMHC) to conduct onsite induction of buprenorphine. Expedited methadone induction SUD assessment and referrals.
That CMHC, Horizon Health Partners, had low rates of substance use disorder (SUD) being assessed. “I don’t know why,” said Linda Hurley, CODAC president and CEO, who talked to AT Forum a month after the project started. “I don’t think the CMHC is as comfortable with medicines for opioid use disorder or all medication assisted treatment for SUD.” Now, CODAC and BH Link can provide induction or intervention on every shift, whether naltrexone for opioid use disorder (OUD) or alcohol use disorder, or buprenorphine for OUD, she said, adding “recently we’ve rapid access to methadone.”
This kind of program is essential because of the 24/7 function. For methadone, induction can’t be started at 2:00 in the morning, but “we can provide comfort meds” until the OTP opens at 5:00 a.m., said Hurley. “We keep individuals as safe and comfortable as possible, in a welcoming environment until the OTP opens and they can then receive their medication.”
Patients needing treatment will be transferred to CODAC from the BH Link site in the CMHC the next morning.
Comprehensive transportation is included with the program, with EMS bringing patients in. And it’s not only for addiction. “If someone comes in in the middle of psychotic break, they can be diagnosed and transported to a place where they can be safely treated,” said Hurley. “Whether someone is very depressed, or mildly depressed, complex diagnoses and referrals can be made.”
Hurley doesn’t talk about “warm handoffs,” but rather, “hot handoffs,” referring to the process of making sure patients get where they want to be. “We ask, ‘Do you want to be here? Where is your home community?’”
Addiction is a highly complex disease, currently being simplified in order to increase access – as in “don’t worry about it, buprenorphine will work for everyone.” It doesn’t work for everyone, said Hurley. Like in most diseases, the correct medication is the one that works for the individual. “Choice is critical for effective care,” Hurley added.
Why EDs aren’t enough
There are recovery support specialists in emergency departments in Rhode Island, but the downside is that many of them do not specialize in OUDs. The frame of mind of patients seeking help in an ED is desperate. Someone needs to be able to say “’We can see that you’re starting to be in withdrawal, what do you need?’” said Hurley. “When you’re in an emergency room, that’s not a conversation most people have.” The bottom line: patients with OUD get less than optimum care in an ED because the care needed is not what EDs are designed or staffed to provide.
“I am so excited to have joined an agency that is able to take action on the State’s plan to prevent overdose,” said Rebecca Boss, COO/Vice President of Strategic Development for CODAC, in an announcement of the 24/7 coverage. “CODAC is committed to responding to our community and bring high quality services to individuals struggling with addiction – whenever and wherever it is needed”. Boss was formerly Director of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), which is paying for this program.
CODAC is also expanding their full MAT services in two different Rhode Island locations as part of an effort to increase addiction services amid a rise in opioid overdoses.
All three approved medications for OUD have been available from BH Link, which allows patients to being medication the same day they ask for help.
And soon, CODAC will be opening a full OTP at the Thrive Behavioral Health center, next to Kent Hospital in Warwick, which is hard-hit by the opioid crisis.
Unfortunately, 2020 is seeing increased opioid overdose deaths in the state (see https://health.ri.gov/data/drugoverdoses) for stats and state responses.