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Team-based approach helps patients fight – and win – battle with opioid addiction

OHSU IMPACT program a national model for treating opioid and heroin epidemic
Honora Englander, M.D.
Honora Englander, M.D., OHSU School of Medicine professor of hospital medicine.  (OHSU)

Opioid abuse and addiction is a tremendous national problem, claiming thousands of lives and doubling the number of people who reported heroin addiction in a single decade (2003 to 2013). The White House is recognizing Prescription Opioid and Heroin Epidemic Awareness Week, Sept 18-24, with a series of events across the nation.

At OHSU, a group of clinicians and care providers have developed partnerships and a unique model to help people overcome their addiction and reduce the burden on the health care system.

Honora Englander, M.D., an associate professor of medicine in the OHSU School of Medicine, leads an initiative that brings together physicians, social workers, peer-recovery mentors and community addiction providers to tackle the root causes of addiction when patients are admitted to the hospital. It’s known as Project IMPACT, or the Improving Addiction Care Team.

The project started in 2014, when clinicians began to recognize a glaring need.

“There was an enormous gap in substance use care,” Englander said. “In the hospital setting we had no ability to assess, let alone address, people’s addiction needs.”

Many of those patients end up in the hospital in the first place with infections such as endocarditis and spinal infections – a health-care crisis that cost $15 billion in inpatient hospital charges related to opioid use disorder nationwide in 2012. Hospitalization treats the acute symptoms of overdose or infection but hasn’t typically addressed the underlying cause of substance use disorder. This results in people cycling endlessly through the system, driving up costs and failing to help people end their addictions.

That began to change when OHSU launched IMPACT in 2015, when senior leadership from OHSU and Central City Concern asked Englander and others to develop meaningful improvements. Now, physicians, social workers, peer-recovery mentors and community partners have developed integrated care systems and ensure each patient has the resources he or she needs to recover.

“Addiction is chronic brain disease, and IMPACT has created a sea change in the way that we care for people in the hospital,” Englander said. “Now we can engage patients, initiate medication-assisted therapy, and link people to substance use treatment care after hospitalization. And we are seeing that treatment reduces stigma and changes culture, an essential part of addressing the opioid crisis.”


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