Closing a gap in addiction treatment
For years, hospitals lacked expertise. Mass. initiative aims to change that.
Each year, hundreds of people addicted to drugs and alcohol show up at Massachusetts hospitals suffering agonizing withdrawal symptoms such as violent shaking and vomiting. Often, they are sent on their way with a list of numbers for local treatment programs.
Yet when Dan arrived last spring at Massachusetts General Hospital with a fever of 105 and the ultra-lethal opioid fentanyl in his system, he was treated to a much different response. Within hours, an addiction treatment specialist visited Dan in his hospital room and asked him what he needed to feel better. He was prescribed methadone, a drug that eases withdrawal symptoms and cravings, and connected to outpatient counseling.
“The experience was life-altering,” said Dan, 46, who declined to share his full name due to concerns over the stigma associated with drug use. “It was the first time that a hospital treated my pain and addiction without judgment. I could think straight again.”
For decades, programs that treat people with addiction have operated largely outside the inpatient hospital setting. Hospitals employ specialists who treat all sorts of ailments, from heart disease to pneumonia, but if the illness is an addiction or related to substance abuse, most hospitals lack the expertise and resources to treat them. As a result, patients with serious addictions are frequently discharged without plans for treatment — a missed opportunity to help more people recover.
Now, this longstanding gap in the state’s health care system is rapidly closing — driven by the relentless scourge of overdose deaths and emerging evidence that hospitals play a vital role in responding to the opioid crisis.
This July, under contracts with the state, 15
hospitals and hospital systems in Massachusetts will launch or expand teams of addiction specialists who can start patients on medications and treatment programs at their bedside. The new teams represent the most significant expansion of hospital-based addiction treatment in decades, and will be supported through $16 million in grants from the statewide Opioid Recovery and Remediation Fund, which is funded with legal settlements with the opioid industry.
A multitude of studies have shown that embedding teams of addiction specialists within hospitals reduces the severity of substance use, increases participation in treatment, and dramatically reduces hospital readmissions — all of which save lives and taxpayer dollars.
“In treating [addiction] like any other disease, I truly believe this [initiative] will be transformational for people who end up in the hospital,” said Deirdre Calvert, director of the state Department of Public Health’s Bureau of Substance Addiction Services.
The need has never been greater. The decades-long opioid epidemic has entered a perilous new phase, marked by the rapid spread of fentanyl and other toxic substances. More than 20,000 residents of the state have died from opioid-related overdoses in the past decade, including a record 2,359 people in 2022, state records show.
Yet despite the toll, hospitals have been slow to bring on addiction specialists. Only about a half-dozen of the 62 acute-care hospitals statewide have multidisciplinary addiction consultation teams like the one at MGH. They include Boston Medical Center, Holyoke Medical Center, Lowell General Hospital, South Shore Hospital in Weymouth, and UMass Memorial Medical Center in Worcester.
One of the key obstacles is funding: Many of the services offered by such specialists, such as care consultations and social work, are not reimbursed by public and private health insurers. And hospital-based addiction teams can be time-consuming to build; to be effective, they rely on long-term partnerships with outside treatment providers and clinics, according to hospital administrators.
Further complicating matters, not every person who arrives at a hospital with a drug or alcohol addiction is ready for treatment.
“I think the real work, the work that we have specialists trained for, is this: How do you engage with people who aren’t there yet?” said Dr. Sarah Wakeman, senior medical director for substance use disorders at Mass General Brigham, the state’s largest hospital system. “And that’s part of what we should be able to do.”
Another obstacle is the stigma associated with addiction. It runs so deep that, in many cases, hospital patients with substance use disorders are treated like criminals. They may have their possessions confiscated, undergo room searches, and have limited or no visitation, among other punitive practices, according to a report released in February by RIZE Massachusetts, a Boston-based nonprofit working to end the overdose crisis.
“We’ve heard stories of emergency room [staff ] saying, ‘Stop coming back here, you’re an alcoholic. Go to detox,’ ” Calvert said. “We’ve heard stories of [staff] calling them horrific names, or not treating them with any medication or taking them off their medication.”
In many cases, the inpatient experience can be so humiliating that people in the throes of addiction actively avoid hospital care — and often leave hospitals before it is medically safe. A study last year by University of Pennsylvania researchers found that one in six patients admitted to hospitals with opioid use disorder leave before their care team considered them safe.
Cheryl Kulacz said her son, Curran, might be alive today had he received better care when he was hospitalized.
Curran spent 12 years struggling with drug addiction, cycling in and out of hospitals across New England with ailments related to his illicit drug use. Once, he arrived at a hospital emergency room with blisters on his hands from smoking crack cocaine. Another time, he was admitted with dangerous bedsores from being sedated for hours on opioids. Yet despite Kulacz’s pleas for help, Curran was repeatedly discharged without any addiction medications or plan for outpatient treatment, she said.
On April 22, 2022, a month after being hospitalized with pneumonia, Curran overdosed at his apartment in Natick. He was pronounced dead at the hospital, yet no one at the facility called to notify the family, Kulacz said. He was 27.
“We always felt like the hospital was the most dangerous place for Curran to be,” Kulacz said. “It was like watching my child lying on the tracks with a train coming and not being able to get him out of the way, over and over again.”
The inpatient and emergency room experience is drastically different at the hospitals statewide with addiction treatment teams.
At BMC, patients with substance use disorder have had access to a team of rotating specialists, including doctors and nurses trained in addiction care as well as social workers and peer recovery coaches. The team can immediately start patients on medications and work with them until they find care closer to home.
The first goal, say specialists, is to make patients comfortable: At MGH, team members bring patients fresh clothes and coloring books to help them pass the time.
“It’s difficult to handle the actual long-term chronic illness, which substance use is, if at that moment in time, they are not comfortable or in agony,” said Dr. Samuel Nwaobi, an addiction medicine fellow at MGH.
Apart from the grants, the state Department of Public Health is working to get MassHealth to cover more hospital-based addiction services, which would make the programs more sustainable, Calvert said.
Dan still credits the addiction treatment he received a year ago at MGH for giving him the tools to stay sober. He now works full time at an auto parts store and has space in his life for his wife — changes he never thought possible when he was still taking heroin.
“In all honesty,” he said, “if it wasn’t for [the MGH team] taking such a sincere interest in my well-being and really caring, then I might not be alive today.”