Addiction Consult Teams differ hospital-to-hospital and are still not offered by many. But they typically include three complementary specialists: a covering physician who is boarded in addiction medicine (which means having completed a subspecialty certification for the evaluation and care of people with substance use-related diagnoses); a social worker trained in working with vulnerable populations; and a certified peer with lived experience. 

Combined, they can provide support and advocacy for hospital patients who use drugs, as well as potentially lifesaving medical interventions such as medications for opioid use disorder (MOUD).

“I think what initially triggered the need was the increasing rates of patients self-discharging early.”

Marginalized people who use drugs face a litany of untreated medical needs, including both physical harms related to drug use under prohibition and disproportionately skyrocketing co-occurring disorders. One shameful contributing factor is how hostile many health care settings have been for drug users.

Consult teams have previously existed for multiple medical specialties, but ACT have been spreading only recently. As of 2019, “more than half a dozen” hospital-based services of this kind existed in North America; while more exist now, they’re still absent from most health care systems.  

“I think what initially triggered the need for a specialized team in hospitals was the increasing rates of patients self-discharging early,” Dr. Sam Huo, who is boarded in addiction medicine and has worked on ACT in both Camden, New Jersey, and Philadelphia, told Filter. “We needed to at least keep patients comfortable enough through their withdrawal in order to support their medical needs, and being able to have a specialized team to support their care also helps to mitigate stigma that may intentionally or unintentionally exist in the care space.”  

Sherry, a Philadelphia resident who preferred that a pseudonym be used, has had many past experiences of stigma in health care settings. But she described how the hospital ACT changed things for her during one visit.

“If it wasn’t for an advocate that intervened, I would have never been admitted and never have received the supportive tools.”

“I remember sitting in the emergency room and a nurse and security guard tried to make me leave, because I fell asleep and I missed my name being called,” Sherry told Filter. “If it wasn’t for an advocate that intervened and explained my need for pain management, I would have never been admitted and never have received the series of supportive tools that followed.”  

Upon admission, Sherry was visited by members of the ACT at various stages. During these interactions, she said, they validated her traumas and the discomfort she was experiencing. She felt that they were on her side, and that—for once—she could actually trust a health care worker. 

Beginning in 2020, Sherry experienced homelessness in Kensington, Philadelphia, having returned to using drugs in order to help her cope with the loss of her mother. Many things added to her distress in this period. One of them was not being able to regularly wash or care for her long, vibrant hair. 

“My hair was so matted from living on the street, and then having spent all that time in a hospital bed it got worse,” she said.

In this context, a simple gesture held great meaning for her. “The nurses and team brought me in real shampoo and conditioner, and they sat on my bed with oils and combs to help work through my hair. We bonded as women and I felt like a human being and not a patient.” 

“After a review of the first year, we saw that having a consult service actually led to reduced overdose mortality for our patient population.”

Dr. Deanna Wilson, boarded in addiction medicine, works in conjunction with the ACT in Philadelphia. Calling ACT implementation both necessary and possible, she said it’s vital for providers like her to get structural buy-in by making the case for these services to health care systems.

“In my previous role, we started with a pilot addiction consult service, and pretty quickly received multiple referrals across the hospital, which helped prove the apparent need we were anecdotally recognizing,” Wilson told Filter. “On a functional level, we were able to provide medications to folks that otherwise would not have access.” 

This had a tangible lifesaving impact, she continued. “After a review of the first year, we saw that having a consult service actually led to reduced overdose mortality for our patient population. This was largely [through] having a specialized team starting patients on MOUD during their hospital stay.”  

An inpatient stay buys time for a person to be able to have their care properly addressed, their medications managed, and for medically supported induction, if they wish, on either buprenorphine or methadone (within strict limitations, due to federal methadone restrictions). It can also give social workers time to begin navigating around various needs that cannot be addressed in an overnight or weekend stay. 

“We all have an equal seat at the table each morning during rounds, and collecting those different viewpoints help us make a cohesive plan.”

As well as assisting patients directly, the ACT model may prompt providers to think differently.

Eric Ezzi is a Certified Recovery Specialist (CRS) who himself identifies as in recovery. He works as part of the Philadelphia ACT, alongside Drs. Huo and Wilson, and said that this role has helped to reshape how he approaches folks on his caseload.

Ezzi’s personal background is in 12-step programs and abstinence-based recovery, which he described as “my stepping stone into this world.” However, his ACT work has underlined to him that there should be no one-size-fits-all approach. 

“Being on a team that is interdisciplinary has helped me strengthen my toolkit of options for people,” Ezzi told Filter, “whether it’s just friendly support, connecting them to meetings, SMART Recovery, or MOUD options. From 8-4:30 you don’t have a singular version of me as a CRS, you have me as a person that can offer you the multiple forms of support that exist, and it is my job to continuously grow within that.” 

“I work with people that are willing to challenge their own expertise and listen to what each person has to offer in terms of care for a patient,” he continued. “We all have an equal seat at the table each morning during rounds, and collecting those different viewpoints help us make a cohesive plan. I think its best practice for each and every one of our patients to have a doctor’s viewpoint, a social worker’s viewpoint and a peer’s viewpoint, because our folks have complex needs that all deserve to be met. If we have a patient-first approach, this is what it looks like.”

As for Sherry, she’s currently in recovery housing, after the hospital ACT helped her secure a scholarship to live there for a few weeks. This, she said, “has allowed me to focus on my healing and not immediately stress out about needing a job to make rent. They also set me up with a prepaid phone, and without that, I wouldn’t be talking to you today or be able to call my aunt who helps care for my child.”

Addiction Consult Teams can only play a small role in mitigating the deep structural issues that harm people who use drugs. But if implemented effectively, they can make big differences in individuals’ health care experiences and broader lives, reducing both overdose risk and co-occurring harms.

Photograph via Pxhere/Public Domain

The post Hospital Addiction Consult Teams Seek to Fight Stigma, Meet Needs  appeared first on Filter.

“[The doctor] laughed me off,” he told Filter. “The doctor said he had been seeing patients for over 20 years and knows an IV user when he sees one. If I was any other patient there for any other reason, I think I would have been trusted more … I left even more afraid because, at that time, the doctors didn’t even know what was happening to me.”

This experience is one of countless that have harmfully impacted people who use drugs and their willingness to enter a hospital for services.

The emergency department is the entry point to care for so many folks who are not connected to traditional health care services. People who use drugs and other marginalized populations are subjected to many systematic harms. The breakdown of trust is one consequence.

If health care workers are not creating a safe space at the gate, the chances of a person returning or staying alive are sacrificed.

“As a Black man from West Philadelphia, certain things get propagated into our communities. For us, it was Suboxone clinics,” said Richardson, who no longer uses illicit drugs and is a certified recovery specialist working with peers and families. “It’s hard to trust what the medication can do when no one has ever taken the time to explain how it works. You can’t help but feel that you are lumped into a general demographic—how can trust build from that?”

If health care workers are not creating a safe space at the gate, the chances of a person returning or staying alive are sacrificed.

For the last three years, I have worked in the acute care setting in an emergency department in West Philadelphia. I have grown to love this community, and credit so much of my learning to my patients, who help me better understand both their needs and their perspectives.

I was hired to lead opioid use research in the department in 2020, just as the COVID-19 pandemic began to hit the United States. This position offered me a unique opportunity to fulfill my job tasks of clinical research while simultaneously being an advocate for patient-directed needs.

It was at that point I learned that there was culture change happening across the care spectrum. I also learned that progress was slow, at best. Yet I was able to find allies in the department to help support day-to-day change.

My team makes a point to meet folks at the door when we know they are coming in, so as to not have them go through security alone: an often-traumatizing experience, especially for people who have been impacted by the carceral system. Whether we are holding a patient’s hand while the tech searches for a vein or we’re equipping them with harm reduction kits, we fully recognize that rebuilding patients’ trust and having them feel supported is critical for their wellness.

Rachel McFadden, a nurse in both the emergency department and a wound-care clinic at a Philadelphia-based harm reduction organization, has been a clinical champion of shifting hospital culture when it comes to caring for people who use drugs.

Language is a great place to start when trying to remove stigma, and McFadden saw an opportunity to promote person-first language training for nurses in the emergency department. Her initiative has now fostered a small but positive change for the patients it serves.

Stand-out programs throughout the country are also pioneering necessary harm reduction interventions in health care settings—such as providing safer-use supplies, as we do in our own department.

Northern Inyo Healthcare District in California is a great example, thanks to former lead advocates Arlene Sun and Steven Dondero, who encouraged hospital-based syringe service programs (SSP). The pair also co-founded Skoden Native Harm Reduction Services under Crossroads Recovery Services, the first SSP tailored for Indigenous people in California. They now consult with other health care systems on how to bridge harm reduction and substance-use navigation gaps in clinical settings.

This interaction often sparks a deeper conversation about why the more compassionate reaction didn’t come naturally to the colleague at first.

McFadden’s work in West Philadelphia is informed by her recollection of receiving little-to-no real training in substance use or harm reduction during nursing school 10 years ago. She’s observed a slight curriculum shift since then; the same institution now offers special seminars on opioid use disorder, led by faculty who are experienced in substance-use care and harm reduction. But this is not a mandated course. Nor are such training opportunities standardized across all nursing programs in the country.

Additionally, while physicians are often expected to continuously take on new knowledge and evidence—via conferences, and grand rounds where colleagues share experiences and innovations—these expectations and opportunities often aren’t applied to the nursing community.

This gap, McFadden believes, places an onus on teaching at the bedside—in a way that meets both the nurse/provider and the patient where they’re at.

“When I interact with a colleague who is struggling with their feelings towards a person, I approach the patient the way I normally would,” she told Filter. “And then later that care provider comes back and says, ‘I really appreciated how nice you were to that patient.’”

This interaction often sparks a deeper conversation about why the more compassionate reaction didn’t come naturally to the colleague at first. McFadden’s example of care in a high-stress setting, she finds, can shift colleagues’ approaches going forward, leading to better experiences and outcomes for patients.

McFadden promotes peers in the clinical space, but emphasizes that their role does not remove individual accountability for other health care workers.

Having peer recovery specialists in the clinical setting has been another key strategy in supporting culture change and better outcomes. Peers can offer insights and connections to patients that no one without that experience really can; their place in this work is invaluable.

McFadden promotes peers in the clinical space, but emphasizes that their role does not remove individual accountability for other health care workers.

“Health systems and clinicians often place the heavy emotional work on a peer, instead of taking on that work themselves,” she noted.

But she added that shifting attitudes about people who use drugs “is a self-work project for a lot of people,” and that “we all have personal work to do to overcome our biases and judgments.”

“Meeting people where they’re at,” means doing exactly that for people who use drugs, of course. But it also applies to the work to challenge health-care stigma that McFadden, I and many others are doing. Self-righteousness isn’t a win; it pushes people away into shame, and shame doesn’t lead to good outcomes. So positive examples, encouragement, listening and constructive education are the path we choose. Creating a safe space where a teaching moment is possible is key.

Photograph by Brittany Salerno

The post How to End Stigma in Hospitals Against People Who Use Drugs? appeared first on Filter.