Program Provides Bridge to Recovery for Patients With Opioid Use Disorder

In 2020, the WVU Rockefeller Neuroscience Institute Department of Behavioral Medicine and Psychiatry partnered with the Emergency Department at WVU Medicine J.W. Ruby Memorial Hospital to implement the IMPACT Project in order to improve access to and retention in treatment for opioid use disorder (OUD). The IMPACT Project is funded by a State Opioid Response grant through the West Virginia Department of Health and Human Resources (WVDHHR) and the Substance Abuse and Mental Health Services Administration.

IMPACT – which stands for Initiation of Medication, Peer Assistance, Connection to Treatment – provides access to medication and resources for adult patients in the Emergency Department who present with OUD-related problems, providing a bridge to recovery. IMPACT operates in the same manner as Mosaic Group’s Reverse the Cycle Program, which has been implemented in more than 30 hospitals across the country, including at most WVU Health System hospitals.

“IMPACT and Mosaic are two programs that do the same thing,” Christopher Goode, MD, WVU Medicine Emergency Medicine chair, said. “IMPACT is funded by a WVDHHR State Opioid Response grant and is solely on our J.W. Ruby Memorial Hospital campus. The Mosaic Project is statewide and federally funded through the DHHR and the Overdose Data to Action grant.

“Both programs implement the same thing, peer recovery coaches linking to care for opioid use disorder in hospitals. Our team at J.W. Ruby Memorial Hospital built the Epic piece and Mosaic provided education for our system hospitals to enable them to make connections to community behavioral health centers.”

Emergency Department patients with identified OUD-related problems are identified by providers and referred to peer recovery coaches in the Emergency Department for support. If patients receive a score of 10 or higher on the Clinical Opioid Withdrawal Scale and are open to treatment, they are referred to receive buprenorphine in the Emergency Department and are scheduled for inpatient or outpatient treatment based on their needs.

“The peer recovery coaches are really the crux of this program,” Dr. Goode said. “Early on, our goal was to reduce the stigma around medication assisted treatment (MAT). We were able to get past that fairly quickly and our biggest opportunity became identifying patients where they are. These patients don’t come into the Emergency Department specifically to say they have a problem with opiates. We are able to recognize the signs and symptoms of opioid use-related conditions and use our screening tools to get them the help they need.”

If the patient’s Clinical Opioid Withdrawal Scale score is less than 10, indicating they are not experiencing moderate or severe withdrawal, an Emergency Department physician with a DEA X-waiver can prescribe up to three days of buprenorphine to provide the patient a bridge MAT.

“The DEA has recently lifted several barriers to receiving an X-waiver and we’re seeing a growing number of Emergency Department physicians who are able to prescribe buprenorphine and bridge the gap until the patient can begin treatment,” Dr. Goode said. “This is especially valuable because we’ll see patients present on a Friday or Saturday and they have to wait until Monday to be admitted into treatment. This really helps them keep from using and possibly overdosing in that time.”

The peer recovery coaches continue to work with the patients as they undergo MAT through the WVU Medicine Chestnut Ridge Center and follow them throughout their treatment to provide recovery support.

“Our goal is to help bridge the gap from the time the patient agrees to enter treatment to the time they are able to begin that treatment,” James Berry, DO, WVU Rockefeller Neuroscience Institute Department of Behavioral Medicine and Psychiatry chair, said. “The immediate support provided by the initiation of buprenorphine to help manage withdrawal symptoms and peer recovery coaches help patients in the one to three days before they begin treatment. Taking the first step to recovery is the most difficult, and this eases the transition.”

Primary outcomes from the first two years of the program have shown a two-fold increase in engagement in addiction treatment, reduced self-reported illicit opioid use, and decreased use of inpatient addiction treatment services. As of March 2022, peer recovery coaches interacted with 1,205 patients, with 150 patients receiving buprenorphine in the Emergency Department.

“We’re seeing preliminary successes with this program,” Dr. Berry said. “While the willingness of patients to enter treatment and recovery is the largest limiting factor, we are seeing better retention rates in those who choose to participate.”