Over the next two years, physician members from various disciplines in Victoria will collaborate on a quality improvement initiative to help opioid users move from the ED to services such as family medicine and community addictions medicine.
The Shared Care Initiative, which includes new ED protocols such as universal screening for Opioid Use Disorder (OUD) at triage, aims to build capacity of community physicians to assess OUD and prescribe Opioid Agonist Therapy (OAT), particularly for patients stabilized at the Rapid Access Addiction Clinic (RAAC).
The project comes after ED physicians and nurses highlighted the need for more community services for OUD patients, as there is not enough capacity for timely OAT in the community to help patients to reduce their reliance on ED services.
“Our OUD project is helping to address a critical need to improve care for those struggling with opioid use and withdrawal in our emergency rooms,” says Dr Nathan Stefani, Project Physician Co-lead, Addictions Medicine Dr and Emergency Room Physician. “Through enhancing educational opportunities, bolstering presence of peer support, and new protocol creation, we are aiming to enhance health care providers awareness and resources to better serve this resilient and yet far too often marginalized population.”
A healthcare utilization study of people who overdosed in B.C. in 2018 showed that 60% visited the ED in the year prior to the overdose event, while the rate of unintentional overdose deaths among those who had had a previous overdose event was 100-fold higher than that of the general population.
Coordination and continuity of care are considered essential to help these OUD patients, including a robust and supportive structured protocol for OAT initiation and support in the community for patients who seek follow-up care.
Nate, 34, had been using opioid drugs in increasing amounts for six years, losing his job, home, and becoming estranged from his family after stealing money from them to support his addiction. He sought help at Royal Jubilee Hospital, receiving a micro-dose initiation on Suboxone and a referral to the Rapid Access Addictions Clinic (RAAC) for follow-up. Nate also received hydromorphone to help manage withdrawal symptoms.
The physician at RAAC was able to refer Nate to a low barrier downtown clinic that provided ongoing OAT and supportive counselling. Allied health staff associated with the clinic helped Nate secure supportive housing and he has since been free of street drugs for three months and is looking to reconnect with his family.
The outcome was different for Sarah, 26, who also received a micro-dose initiation on Suboxone and a referral to RAAC. Although Sarah had intended to visit RAAC, she lived further out of town and couldn’t make it there on time. She did visit a local walk-in clinic, but it did not provide OAT. The following month she had died from a presumed overdose.
The program will continue to be refined, including a focus on educating ED physicians and nurses on new triage and opioid withdrawal protocols, OUD referrals and resources, and in-house peer support programs, and advocating for increased wrap-around peer support in the ED, especially during evening hours, in collaboration with Island Health. An Overdose Discharge Package to aid OUD patient transitions from the ED is also in the works.
The plan is for Urgent and Primary Care Centres to start accepting and managing stable OAT patients discharged from the RAAC and build capacity within local Primary Care Networks to assess and manage OUD patients stabilized on OAT.
Interested in finding out more? Email Sara Healing, project lead. This project was funded by the Shared Care Committee, a joint collaborative committee representing a partnership between Doctors of BC and the Government of BC.
