In response to a growing heroin and opioid addiction crisis, Butler Hospital in Providence, R.I., opened an outpatient detoxification unit.
The ambulatory program at Butler (which is part of the Care New England health system) since September has been providing medically managed safe withdrawal from heroin, opioids, or other prescription medications and also alcohol, to adults 18 years or older.
Drug overdose is the leading cause of accidental death in Rhode Island, according to the state Department of Health. The Office of the R.I. State Medical Examiner reported 141 accidental drug overdose deaths through October in 2015, and 241 deaths in 2014.
Division of Emergency Medical Services reports between 118 and 159 doses of Naloxone, also known as Narcan (a medication to reverse the effects of opioids and prevent overdose) are administered each month by EMS personnel in Rhode Island.
The addition of outpatient detoxification services to Butler’s recovery program – which also includes inpatient and partial hospitalization services – provides another point of access for treatment for Rhode Islanders struggling with addiction, according to Mary Ella Dubreuil, RN, MA, LCDP, LCDS, director of alcohol drug treatment services at Butler. She said many patients in the past have been unwilling to go into the hospital, because of stigma.
“What we’re seeing now with opioid and pain medication, we’re seeing people who never dreamed they’d have an addiction,” she said. “These are not people who want to come into an inpatient unit. Some of the people I talked to said they would never have started a recovery program if it wasn’t for (the outpatient) program. We’re touching more lives this way.”
Opioids are typically prescribed for pain management (for patients who have had surgeries or are dealing with chronic pain). But addiction can happen quickly. “These are insidious medications,” Dubreuil said. “At first, they really do serve their purpose … but they are not innocuous medications.”
Once a prescription to pain medication runs its course, some people will turn to a street drug like heroin that’s more easily accessible.
Dubreuil said in the past, it was difficult to run outpatient detox programs because the medications to support the recovery weren’t as successful and often had uncomfortable detoxification side effects.
Now, “new medications to support recovery have changed the environment, and made it possible for people to be successful in their recovery,” she said. “You can really help a person quickly. I think that makes a difference.”
The ambulatory program identifies qualified participants through a thorough screening process. Patients must have transportation to the program, have a supportive home environment, have no medical or psychiatric conditions that require an inpatient level of care, and have minimal risk for severe withdrawal and no history of DTs or seizures in withdrawal. “We are very, very careful about who we admit,” Dubreuil said. “Their success depends on us being able to assess them as a strong candidate.”
The multi-disciplinary treatment team specializes in addictions treatment. Treatments are individualized to a patient’s needs. A treatment course typically includes three to five consecutive visits to administer medications under nurse supervision.
An on-site pharmacy allows patients to pick up prescribed medications before leaving the campus for self-managed care overnight. Family education is provided. Patients also have access to emergency support, and because the program is hospital-based, patients can transition to inpatient care if necessary or transition to other levels of outpatient recovery services and community supports once they’ve completed the program.
“When they finish the ambulatory detox program, we have the ability to get them immediately into a rehab program right down the hall and we have many, many connections with other addiction services of all levels, through Butler or Care New England,” Dubreuil said.