Mt. Ascutney Hospital and Health Center Emergency Department Addresses Opioid Crisis with Medication Assisted Treatment and Narcan

In order to save lives from the opioid crisis affecting Windsor County, Mt. Ascutney Hospital and Health Care Center (MAHHC) is offering rapid access to Medication Assisted Treatment (MAT) for people who arrive in the Emergency Department after an overdose or simply seeking help for an opioid use disorder. To provide this care—a process known as MAT Induction—MAHHC is working with Connecticut Valley Addiction Recovery (CVAR), an addiction treatment center in Windsor. In addition, MAHHC and CVAR are collaborating with the Vermont Department of Health to distribute the nasal-spray naloxone (Narcan) for free to the public.

Narcan is a life-saving drug that can reverse the effects of an opioid overdose when administered in time, while MAT is the use of medications such as Suboxone in combination with counseling to help people sustain recovery from substances. As opioid-related deaths are on the rise nationwide during the coronavirus pandemic (American Medical Association: Issue Brief, October 2020 - PDF), Vermont has had 100 opioid overdose fatalities between January and August, 2020. Windsor County, with 21 deaths, has experienced the highest number of any Vermont county (Vermont Dept. of Health: Opioid Related Fatalities Among Vermonters: Monthly Update: October 2020 - PDF).

Qualifying patients receive their first dose of Suboxone in the MAHHC Emergency Department. The E.D. takes on the referral process and connects these patients with next day follow up care at CVAR. These efforts are grant funded. MAHHC has received an Overdose to Action grant from the Vermont department of Alcohol and Drug Abuse Programs (ADAP). CVAR received a Rural Communities Opioid Response Program grant from the Health Resources and Services Administration (HRSA).

Dr. Rick Marasa, Medical Director of Emergency Services at MAHHC, collaborates closely with Dr. Clifton Lord, an addiction medicine specialist and Medical Director of CVAR, to ensure patients receive seamless care from the time they arrive in the Emergency Department, through their release from the hospital, as well as the critical period afterward.

Dr. Marasa said he and his colleagues have seen increasing opioid-related issues in the MAHHC Emergency Department in recent months. He and his staff are trained to identify people who need rapid access to treatment and to communicate with them about their disorder. Dr. Marasa explained, “If we see anybody who has a potential for needing any kind of drug or alcohol treatment, but especially now, opioid treatment, we engage in motivational interviewing. We get an idea of where they are with recovery, and make some suggestions.”

If patients are willing, Dr. Marasa’s team provides the first dose of Suboxone in the Emergency Department. “But in order for people to really recover and have long term success,” he added, “they need close follow up with an addiction specialist.” That is when he reaches out to Dr. Lord and the team at CVAR who provide continuing Suboxone, case management, and counseling. Dr. Lord hopes the Emergency Department’s MAT Induction will lower the barrier to treatment and save more lives. “We make sure that when a patient is seen in the ER, it becomes clear to them that we’re glad to see you, we're here to help,” he said.

Dr. Lord of CVAR stressed that substance use disorder is a chronic illness, just like high blood pressure and diabetes: “I daresay anybody who thinks that dependency on opioids is a choice, and thinks that somebody could just stop, would never put up with the discomfort these patients deal with when they stop.” He emphasized that recovery includes medical, behavioral, and social aspects (the latter encompassing employment, housing, and financial issues).

“Yes, there is a crisis,” he said. “Yes, there are people dying. This is a terrible disease. But there are good people out there who are trying really hard to take care of people. I always think that there isn't often very much room for optimism in this work, but there's always room for hope. I have a lot of hope that we can make a difference with this.”

MAHHC’s program and its arrangement with Connecticut Valley Addiction Recovery began in 2019, and grew out of the Hospital’s initiative to address the opioid issue, spearheaded by CEO Dr. Joseph Perras. In 2018, the Hospital held two summits, organized by MAHHC Director of Community Health Jill Lord, which included area providers, social service agencies, legislators, and educators to identify their perceptions of the situation and establish priorities for addressing it, including MAT and free Narcan distribution.

Of the increase in overdoses in Windsor County, MAHHC’s Jill Lord said, “My heart breaks. This is not where we want to be. We identified we had a problem several years ago, but COVID-19 has had an impact.” She added that the situation is “a call for all of us to continue our work both in our agencies and together: Rapid access to medication and therapy, Narcan distribution and education, outreach after every overdose, as well as screening and referral to treatment.”