Bringing “Hope & Healing to Those Affected by Opioids”

With thanks to a warm handoff and a community of support.

Providence Regional Medical Center Everett

Everett, Washington is 29 miles north of Seattle and home to approximately 113,000 Americans, making it the 7th largest city in Washington state and the largest city in Snohomish County. Although Snohomish County comprises only 10% of the state’s population, it experiences around 18% of all heroin-related deaths in the state of Washington.¹

Providence Regional Medical Center Everett (PRMCE) is a full-service medical center offering cardiology, cancer treatment, neuroscience, a birthing center and a Level 2 Trauma Center serving patients from several counties in Washington. It’s the access to so many patients with opioid dependence that inspired emergency physician Thomas E. Robey, MD, PhD, to work toward improved treatment options for people suffering from substance use disorder (SUD).

Dr. Robey

Tom Robey is a Yale School of Medicine graduate, emergency medicine physician, and researcher. He has had a passion for advocacy for people experiencing homelessness since before his medical training days, and Yale-New Haven Hospital’s strong focus on helping this population equipped him to bring new treatment options to his own practice. Tom’s interest was fully developed during his residency, and has driven his career aspirations and guided his professional journey.

“Anywhere you go in the country, you need to address the health needs of people who are unhoused.”
— Dr. Robey

As an emergency medicine resident at Yale, Tom trained under Gail D’Onofrio, MD, MS, who is known internationally for her research in medication-assisted treatment (MAT) induction in the emergency department (ED). This training fueled Tom’s passion to explore ways to provide better care for homeless patients with SUD, to better understand the realities and implications of addiction, and to identify how the two intersect.

When choosing a hospital setting for his practice, Tom’s desire to work in an ED that is big, busy (the largest ER in the state), and one in which he could connect directly with his patients, is what led him to PRMCE.

“Anywhere you go in the country, you need to address the health needs of people who are unhoused,” said Tom. “The emergency department is where the homeless population interfaces with healthcare, and that’s how I knew very early in my training that it’s exactly where I am meant to be.”

But, while MAT induction in the ED was a standard treatment option at Yale-New Haven Hospital, it wasn’t readily available in all hospital settings. Tom had seen firsthand how MAT induction in the ED could reduce illicit opioid use, overdoses and mortality, and he knew how important it was to bring this treatment option to his new workplace, PRMCE.

MAT for Opioid Use Disorder

Medication-assisted treatment (MAT) is the use of medications in combination with counseling and behavioral therapies, which may be effective in the treatment of OUD and can help some people to sustain recovery.

Tom championed the ED MAT induction program at PRMCE and continues to advocate for community-based programs, like Ideal Option, an outpatient center that offers medication-assisted treatment for addiction to opioids, alcohol, and other substances, to which he refers patients for next day follow up.

But, alone, MAT is not enough. The medication is administered until a patient’s behavior is changed, and it’s the behavior change that makes all the difference in a patient’s recovery.

A Warm Handoff

What is the next step in the chain of treatment that can best support a patient with OUD? Successful OUD treatment requires a continuum of care, and it isn’t always easy for patients to navigate complicated, and often fragmented, healthcare systems to get what they need. It is even more challenging for patients experiencing homelessness. Offering support in a time of shame, confusion and pain may need more than a referral or phone number.

“Can some simple interventions improve the warm handoff between the ED and the opioid treatment clinics and, ultimately, lead a patient to follow up their MAT treatment?”
— Dr. Robey

Tom believes the “warm handoff,” where a healthcare provider caring for a patient introduces the patient to the next provider in the healthcare continuum, while seemingly inconsequential, is a 20-second action that can make a world of difference. The warm handoff emphasizes to patients that they’re being cared for and that their life matters.

This belief is what led Tom to his most recent project, COPE ASSISTED: an observational trial to evaluate Clinical Outcomes and Population Effects from A System of Suboxone Induction Started in The ED, which is funded with a grant from Purdue Pharma. In simple terms, Tom is asking if a relatively inexpensive intervention of a warm handoff will improve follow up for OUD and helps battle the opioid crisis in a community hospital setting.

“We’re testing whether a cab ride and a phone call can help someone kick their opioid dependence better,” said Tom. “Can some simple interventions improve the warm handoff between the ED and the opioid treatment clinics and, ultimately, lead a patient to follow up their MAT treatment?”

With a strong partner in the community, and a healthcare team committed to ensuring a warm handoff for every patient receiving MAT induction in the ED, Tom is hopeful that more patients will succeed in their treatment and recovery.

Bringing MAT to the Emergency Department

Tom believes the ED plays a vital role in connecting patients with treatment when their motivation to make a positive behavior change is, potentially, at its highest.

“People struggling with OUD are most likely to interact with medical professionals in the emergency department, either as a result of an overdose or from issues related to their substance use,” said Tom.

When asked his advice for other EDs initiating ED MAT induction programs in their communities, Tom emphasized the importance of the warm handoff, saying “These warm handoffs emphasize to the patient that they’re being cared for. There’s some evidence that introducing the patient to the next doctor in the chain helps their health.” That, and, “take it one step at a time; focus on what the community already has, what it needs, and its readiness for a program like this. Then get a strong community partner and educate, educate, educate.”