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Christiana Care initiative targets opioid withdrawal symptoms

Delaware Public Media

Opioid withdrawal symptoms often coincide with other health conditions that bring people to the hospital.

 

Christiana Care is trying something new to help address opioid withdrawals as soon as possible, often starting in the emergency department.

Christiana Care behavioral health staff development specialist Aliesha Rivera says she’s seen the negative symptoms of opioid withdrawals get in the way of nurses trying to treat patients for other health concerns.

 

“A lot of patients leaving the medical floors against medical advice because they started to go through that painful period of withdrawal," Rivera said. "It’s very uncomfortable so they just get panicked and they just leave without getting any treatment.”

 

That’s why Christiana has been trying a new initiative to improve the health care of those with opioid use disorders.

 

“Specifically, we were focusing on the identification of those in opiate withdrawal in the inpatient medical setting.”

 

That’s Dr. Terry Horton, Chief of Addiction Medicine at Christiana Care.

 

“Because withdrawal is really this primal misery in a way that kind of drives the individuals to behaviors that don’t include judgment and proper risk management, all these sorts of things, you really end up having individuals make bad decision like using drugs in the hospital, or signing out against medical advice," Horton said.

 

Horton adds to treat these issues, they first had to develop a screening tool.

 

He says they couldn’t find any being used by other experts or the National Institute of Drug Abuse to identify opiate dependent individuals going through withdrawal in the hospital setting.

 

“We came up with two questions," Horton said. "And the two questions are: Do you use heroin or prescription drugs other than prescribed, and if you do and you don’t use those do you get sick.”

 

If the patient answers “yes” to this first screening, the nurse moves to the Clinical Opiate Withdrawal Scale, or COWS which helps determine when suboxone - a drug commonly used to treat opioid addiction - should be administered.

 

“If we initiate suboxone too early to an individual who still has the heroin on their opiate receptor, we can actually precipitate opiate withdrawal, we can actually make them worse," Horton said.

 

Horton says piloting the program with a few inpatient medical units first helped start working out any kinks.

He notes one key finding – the need to monitor people for a longer period of time for potential withdrawal symptoms.
 

“When someone begins to have withdrawal, we’ve learned, it’s not just eight hours after the last dose, Horton said. "It might be 24 hours after the last dose.”

 

Additionally, he says suboxone doses needed to be increased to compensate for the higher level of heroin purity that’s available now.

 

“These are individuals who very likely would not have been identified otherwise, who don’t come in self identifying but come into the hospital and begin to have opiate withdrawal which is often either not addressed or addressed in a suboptimal way resulting in poor clinical outcomes and poor patient satisfaction," Horton said.

So far, Horton says not too many people are denying treatment.
 

“Most of our patients who are heroin dependent are not happy in their heroin dependence," Horton said. "They want to move to something else. They’re desperate to move onto recovery, they’re just caught in that horrible cycle of addiction and withdrawal.”

Horton adds early data indicates the program will discover 500 individuals every year who wouldn’t otherwise be identified as experiencing opioid withdrawal - giving then a chance to pursue recovery.
And he hopes this will help not only the patient, but everyone involved in the patient’s treatment and recovery process.
 

“It can be seemingly futile when you seen an individual come in again and again and again and as a provider you don’t have any tools to address their withdrawal, you have no tools to help them get into drug treatment," Horton said.

One major tool they’re also trying to provide in conjunction with the pathway: having peer counselors - individuals who’ve had a similar addiction problem  themselves - available to offer bedside guidance and support.
 

If all goes as planned, the new behavioral health pathway will go systemwide at Christiana Care in November.

 
 

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