New Initiative at Mid Coast Hospital Aims to Stem the Tide of People Struggling with Addiction

Mid Coast Hospital is taking an innovative approach to help people engage in treatment to overcome opioid dependence. Based on a 2015 study reported by Yale University researchers, the approach teams Emergency Department (ED) physicians and behavioral health providers in a collaborative effort that is showing positive results in its first several months.

Called ED/ARC (Addiction Resource Center) Enhanced Referrals for Suboxone and Alcohol, the program is the first of its kind in Maine. ED physicians use newly developed treatment pathways to treat low-risk alcohol withdrawal, opioid withdrawal, and a Suboxone pathway to begin patients on Suboxone while still in the ED. The program provides a screening tool for physicians, and it engages the ED’s Behavioral Health Crisis Team.

"Combined addiction and mental health treatment with FDA-approved medication for opioid use disorder has shown a significant increase in patient access and improved outcomes," said Leah Bauer, MD, of Mid Coast Hospital Addiction Resource Center. "Medications stop withdrawal and relieve cravings so patients can have the best chance of engaging in successful treatment."

Mid Coast Hospital’s ED/ARC Enhanced Referrals program has created a process to identify ED patients who are receptive to treatment, initiate the treatment process, and refer them to Mid Coast Hospital’s ARC for ongoing comprehensive treatment. In most cases, the patient leaves the ED with an appointment at ARC on the next business day.

"The model is based on taking advantage of the opportunity to intervene that an ED physician has when a patient with addiction presents," said Ranjiv Advani, MD, of Mid Coast Hospital Emergency Department. "If that opportunity is not seized at that moment, it may not present again."

Maine, like many states, is struggling with how to stem the use of drugs, including opioids, and treat those who become addicted. In 2017, there were 418 drug-induced deaths in Maine, up 11% from 2016. Mid Coast Hospital is the only hospital in the state with an ED team providing Suboxone treatment to those presenting with opioid dependence.

Prior to this initiative, there was no system in place for how best an ED physician could help a willing patient access the services of ARC. With its ability to schedule new patients promptly, ARC stands apart from many recovery programs in Maine that take weeks or months to access.

"The delay often is a deterrent for people who struggle with addiction," said Dr. Bauer. "This 'soft landing' can be the difference for patients, especially those who have a narrow window of motivation to begin recovery."

The Mid Coast Hospital team has screened many patients in the ED who are not ready or willing to engage in treatment. Between the start of the program in mid-October and the end of January, however, 11 patients were referred to ARC, and nine arrived at their first ARC treatment session.

"In March, we began treating a 34-year-old father of an 18-month old, with an extensive history of misuse and previous treatment episodes. He had an accidental overdose, which was a wake up call for him and led him to seek treatment in the ED to fast track his addiction treatment. We began seeing him the following week and now several weeks later, he continues his treatment at ARC, his relationship with his partner has improved, and he is a successful stay-at-home-dad," said Dr. Bauer. "Stories like these are a testament to how this program can help improve lives and bring people back into functioning roles in society."

"As we continue to see an increase in patients with addiction concerns, clinicians on the front lines now have the tools to provide a solution at a time when we can truly make a difference," said Dr. Advani. "The Midcoast region is fortunate to have these resources in our community."