Can hospital adjust to provide detox-like care?
GREENFIELD — There is the potential for something that could approximate a detox program at Baystate Franklin Medical Center.
BFMC Clinical Pharmacist Ed Tessier, with a group of doctors, nurses, pharmacists, social workers, psychiatrists, psychologists, addiction medicine specialists and case managers from across the Baystate Health system, is developing an opioid withdrawal management protocol that includes screening and treatment guidelines to provide consistent care.
Where opioid-dependent people walking in off the street without a medical complaint beyond withdrawal would fit into the protocol is not yet clear.
Currently, it is generally understood that the only route to detox-style care in a hospital like Baystate Franklin is to say that you want to kill or harm yourself — that’s a ticket to the mental health unit.
Tessier envisions a new route: “We’re trying to coordinate a systemwide approach to build on the good experience we’ve had with alcohol withdrawal management onto opioid withdrawal management for inpatients,” he says.
Alcohol withdrawal can be life-threatening, and therefore has to be treated. The same isn’t necessarily true of opioid withdrawal, but there’s more than one way it can come up; patients in need of surgery who are already saturated with or highly resistant to opioids and need to be brought down, suicidal patients going through withdrawal in the mental health wing, overdose patients brought into the emergency department.
Detox help possible?
The hypothetical structure is three-part: screening to establish the patient’s baseline use, legitimate or illicit, and determine if, say, the patient has been over-prescribed.
Next up is managing withdrawal; keeping the patient safe and comfortable as possible.
“The third issue is working with our case management and social workers and our entire team to transition that patient to an appropriate after-discharge treatment option, so that they’re connected with what’s available in the community,” Tessier said.
“With alcohol it’s worked quite well for us.”
Alcohol has been pretty well settled, although there is possible room for improvement, according to some new literature, Tessier said.
But opioid withdrawal management in hospitals is, well, haphazard. Tessier reluctantly uses the phrase “Wild West.”
Opioid detox facilities often ease the patient off their drug(s) with tapered doses of buprenorphine or methadone, tailored opioids, and anti-anxiety medications.
Among the many underlying problems for doctors is pain; if a patient was prescribed opioids for chronic pain and is now dependent, simply taking away the drugs leaves the original problem.
“What is the nature of their pain, can their pain be managed with something other than opioids, where does the underlying pain end and the symptoms of withdrawal begin?” Tessier said.
Sorting out what studies and literature exist and answering questions like whether to begin prescribing Suboxone if they can’t continue that treatment once the patient is released will take some time.
“Ideally, we’re giving ourselves a year-long process to do it,” Tessier said .
— CHRIS CURTIS