Earlier this year, the office of the Surgeon General released its first advisory in more than 10 years. The advisory addressed the opioid epidemic, a crisis that is sweeping the nation and has surpassed AIDS as the deadliest epidemic to hit the U.S. in a generation.
In addition to taking lives, the opioid epidemic has had severe financial implications for hospital systems across the country. The cost of treating opioid overdose victims in hospital intensive care units jumped 58 percent per admission between 2009 and 2015, from approximately $58,000 to $92,400. This rate greatly outpaced the overall U.S. medical inflation rate of 19 percent during the time period and indicated longer hospital stays and more-intensive treatment plans.
Pictured at right: Garth Graham, MD
Such figures are daunting, and there is no single solution. Each individual, family, and community is waging their own battle. With that in mind, the Aetna Foundation in 2018 announced a $6 million commitment to fight the opioid epidemic in states across the country, providing those on the ground with resources they need to meet their unique challenges.
When Hospitals Can Intervene
In Florida, for example, 18,000 emergency department (ED) visits occurred between June 2016 and June 2017 by individuals suffering from an opioid overdose. From this number, 78 percent of patients were discharged to their homes, 12 percent left against the doctor’s medical advice, and only 10 percent remained in the hospital for treatment.
We’ve heard from organizations throughout Florida that there is a window of time when intervention works best—and that window occurs in a hospital setting. Once patients leave the hospital and use again, the chances that they will reenter treatment dramatically diminish. Florida Hospital Association (FHA) officials have stated that when overdose victims are connected with support within 12 hours of an ED visit, they have a better chance at successful intervention.
Opioid abuse relapse rates are extremely high, so it is important to intervene when overdose patients are most receptive to treatment. Out of the 18,000 ED visits by overdose victims in Florida from June 2016 to June 2017, 10 percent of patients were being treated for overdosing a second time or more, according to the FHA.
In Florida: Addressing the Issue in the ED
With support from a $1 million grant from the Aetna Foundation, the Florida Alcohol and Drug Abuse Association (FADAA), along with the FHA and the Peer Support Coalition of Florida Initiative, is enhancing and expanding programs that offer support to opioid-overdose victims and connecting them with lifesaving resources when they are more receptive to treatment.
The “All in for Florida: The ER Intervention Project,” conducted in collaboration with FHA and the Florida College of Emergency Physicians, aims to ensure patients are safely discharged to a treatment program that is best-suited to serve their individual needs. Closely integrated resources can help those suffering from addiction, providing better access to treatment services—such as community-based behavioral health programs and peer-recovery specialists who have overcome addiction themselves—when there is the greatest opportunity to intervene and address addiction.
The program’s concept was piloted at St. Vincent’s hospital in Jacksonville, Fla., where approximately 450 overdose victims were treated in the ED over the course of a six-month test period. After a successful trial run, the program was expanded throughout the state.
The “All in Florida: A Recovery Project”, conducted in coordination with the Peer Support Coalition of Florida, includes listening sessions around the state to understand the needs of individuals in recovery as well as the development of a statewide advisory board of recovery champions to guide the project. The organization will transition information networks of recovery groups across Florida into accredited Recovery Community Organizations in the hope of building stronger connections among a wide range of related services for individuals recovering from addiction.
It is our hope that the grant will help create a bridge from EDs to treatment facilities for those experiencing an overdose and provide comprehensive services for this vulnerable population.
Creating Scalable Solutions for Communities in Need
In addition to the FADAA, the Aetna Foundation will collaborate with organizations in North Carolina and Pennsylvania to develop community-specific solutions.
The North Carolina Harm Reduction Coalition focuses on challenges facing residents in rural areas who are unlikely to have health insurance, affordable treatment options, or transportation. The Pennsylvania Department of Health is using technology to turbo-charge an innovative opioid dashboard that helps state and county officials better access information through improved data.
It’s encouraging to see the work happening on the ground to make real, sustainable change. We know everyone has a role to play in combating the opioid crisis, and it is our hope that these interventions and key learnings can be replicated in other health systems and communities as they tackle their own challenges.
Garth Graham, MD, MPH, is president, Aetna Foundation.