By Nancy Kirsch
PROVIDENCE – Rhode Island is the first state in the nation to develop standards for emergency departments – in hospitals or as free-standing units – to treat patients who present with opioid-use disorder and/or overdose, the R.I. Department of Health reported at the March 8 meeting of the Governor’s Overdose Prevention and Intervention Task Force.
Developed by members of the Task Force (co-chaired by Rebecca Boss, acting director, R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, and Dr. Nicole Alexander-Scott, director, DOH), as well as many emergency-department physicians throughout the state, these standards are designed to provide consistent, high-quality care, with a goal of reducing the number of deaths from drug overdoses.
The standards establish a three-level categorization system that defines each entity’s current capacity to treat opioid-use disorder. All emergency departments and hospitals will be required to meet the criteria for the lowest level, Level 3; as hospitals gain more acumen in treating opioid-use disorder, they may apply for a higher designation. Traci Green, adjunct associate professor of emergency medicine and of epidemiology at Brown University and a Task Force expert adviser, noted that hospitals and emergency departments will be classified into Level 1, 2 or 3, based on their initial self-assessments and on subsequent evaluations by DOH and BHDDH.
Examples of the Level 3 criteria, which are effective immediately, require emergency departments and hospitals to:
A Level 2 facility would have to meet all these criteria as well as have the capacity to evaluate and treat people with opioid-use disorder; while a Level 1 facility would meet Levels 2 and 3 criteria and maintain a Center of Excellence – which must be approved by DOH – where patients can receive buprenorphine treatment for opioid-use disorder.
Before the meeting, Dr. Josiah “Jody” Rich, professor of medicine and epidemiology at The Warren Alpert Medical School of Brown University, told Providence Business News there are no national standards for treating the disease of addiction. The Joint Commission on Hospitals has lots of standards, including on the use of opiates, but no standards when it comes to treating people with this disease. Rich, who is also an expert adviser to the Task Force, asked a hypothetical question, “Imagine if people came into the emergency department with crushing chest pains and we gave them a list of sites where they could get cardiac care?”
With approximately 20,000 people in Rhode Island who could benefit from Medication-Assisted Treatment (which involves medications, such as methadone and buprenorphine for opioid addiction, in concert with other therapeutic measures), Rich referenced an April 2015 study, Emergency Department-Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence, from Yale University School of Medicine, which found that individuals who began treatment in an emergency department were much more likely to attend their first outpatient appointment within a day or two, and 30 days out to be in treatment, than those who aren’t so treated.
This initiative, which has been a collaborative effort, said Green, is driven by the needs that have been seen. “Patients with opioid-use disorder and their families deserve the same dignity and compassion and medical care as any other patient,” she said. This is an opportunity, she added, for institutions to define for themselves the level of exceptional care they are able to provide.