'Right to a safe place': Program targets gap between hospital, addiction help for opioid patients

Editor's note: This article has been updated to correct the title of Adriane Price, clinical supervisor of the Gateway Warm Hand Off program

Roughly 155 suburban residents treated for opioid overdoses and then released from four area hospitals last year were immediately given the option to obtain additional long-term treatment thanks to a first-of-its-kind program based in Lake County and Chicago.

The program is designed to address the problems of increased overdose risk and difficulty accessing treatment for patients who may still have opioids in their systems or who may be looking to get high again to ease withdrawal pain.

By immediately offering help finding long-term treatment, the Warm Hand Off program by Gateway Foundation Alcohol & Drug Treatment aims to prevent relapses or fatal overdoses and overcome the struggle patients face in finding a suitable facility immediately after leaving hospital care.

"This is still one of those big gaps," said Karen Wolownik Albert, executive director of Lake County Services for Gateway. "That's why this program is so important."

Officials at participating hospitals, including Saint Anthony Hospital in Chicago, Advocate Condell Medical Center in Libertyville, Advocate Good Shepherd Hospital in Barrington and University of Illinois Hospital and Health Sciences System in Chicago, say it helps to have a specialist dedicated to finding next steps.

"Prior to Gateway being here, we didn't really have that community wraparound piece that they provide, which is to be able to follow the case after they (those who overdose) leave," said Rich Dilger, the emergency department coordinator of behavioral health at Advocate Condell.

"Somebody might not be in the mindset to accept the help now, but it doesn't mean they won't be later on."

A year after the Warm Hand Off program began, a fifth hospital, Vista Health System in Waukegan is set to launch the service.

Dangerous detours

Doctors who treat opioid use disorder say downtime between phases of treatment is dangerous because it offers a chance for users to get sidetracked and delay their search for help or seek one final high before beginning rehab.

What's intended as a last hurrah can prove fatal, especially for patients treated with naloxone or Narcan. Anyone revived with these antidotes - which allow breathing suppressed by opioids to begin again - is no longer feeling the effects, but still has the drugs in their system. So if the patient uses opioids again shortly after revival, whether to cure withdrawal or regain a high, doctors and coroners say a smaller amount than expected can cause a repeat overdose and possible death.

But in a health care system stretched on all sides, hospitals often do not have the ability to keep patients in their care very long after they've been revived.

Dr. John Piotrowski, medical director of the emergency department at Advocate Condell, says a lack of resources typically leads hospitals to discharge opioid overdose patients - once the revival drugs have worn off and they're physically stable - with little more than a list of numbers to call for treatment.

"It's not so much when the Narcan wears off, it's more of what their health looks like into the future" that worries doctors, Piotrowski said. "I'm taking care of the first six hours, but really, the hard work is what their life looks like weeks from now."

Getting to the next step of treatment can be a major hurdle, as rehab centers and doctors who specialize in addiction often have waiting lists or only accept certain types of insurance.

That's why the downtime doctors say is so dangerous is a frequent experience after an opioid-related hospital stay, leaving those in need of continued treatment feeling flu-like and desperate.

"Even if people are intending to engage recovering, they'll think, 'Let me just feel better.' What they do to make themselves feel better can cause harm," Wolownik Albert said. "If we can get them right to treatment, right to a safe place, we bypass anything they might want to do on their way out."

Finding further help

At hospitals where Warm Hand Off is offered, Wolownik Albert says patients are met by engagement specialists whose job is to encourage them to continue treatment by identifying a placement. With willing patients, engagement specialists determine which type of treatment would be best, selecting from residential, outpatient, intensive outpatient or medically assisted programs.

Adriane Price, clinical supervisor for the program, says she helps patients understand their risks and choices to encourage them to pursue recovery.

"If a client leaves the hospital, they are more apt to relapse, especially if they're not totally detoxed," Price said. "Their best chance is to get in (further treatment) right away."

To make that happen, Price and the other engagement specialists work through a spreadsheet listing more than 175 treatment options from providers across Cook, DuPage, Kane, Lake and McHenry counties.

Specialists reach out to an average of four providers before finding a place where each willing patient can continue treatment.

But the assistance doesn't end there. The Warm Hand Off also includes transportation to the chosen treatment location and continued follow-up from a recovery coach.

And the program isn't all a ploy to get more patients into Gateway facilities, a point that Gateway leaders say separates the help they provide from other referral services.

"We're placing clients at other providers," said Sally Thoren, executive director of Gateway's Chicago services. "Sometimes 25 different providers in a month."

The spreadsheet of treatment options is what makes the Warm Hand Off so valuable to doctors, nurses and social workers at participating hospitals. It removes the hassle and challenge of finding a proper placement.

"If you're an ER nurse," Thoren said, "the last thing you have time to do is start making phone calls."

In some cases, patients refuse to talk with the Gateway specialist who's trying to get them further help.

But of the 155 patients at Condell and Good Shepherd who have said OK to initial outreach, 115 - or 74 percent - have accepted referrals. That has led to 48 people - 31 percent of those initially contacted - showing up at a first appointment for further addiction treatment.

The results have come since Warm Hand Off launched at Condell in December 2017 and Good Shepherd in January 2018, after first starting at St. Anthony in October 2017. Wolownik Albert said the outcomes show a need for more outreach to opioid patients before they're released from hospital care.

Where the stats fall short is in tracking patient success or failure with treatment after a referral is made. Wolownik Albert said that data isn't available because of staffing, but hospitals are beginning to track repeat opioid patients within their own systems.

As leaders prepare to start the Warm Hand Off at Vista Health System, Gateway is looking to expand the program as a way to fill gaps in addiction care.

"The need and desire for our programming is gaining momentum," Wolownik Albert said, "and we are using this as a chance to demonstrate the impact we can have through these strategic relationships within the hospitals."

Connection to opioid care: Part 1

Facing continuing issues with opioid overdoses and addiction, drug rehabilitation centers and health insurers are doing more to help people who are released from hospitals after initial treatment. Today, the Daily Herald examines one such program offered by Gateway Foundation Alcohol & Drug Treatment and how it's helping bridge the gap between a brief hospital stay and long-term addiction recovery.