In New York City only 1 out of 10 adults struggling with substance use issues accesses any form of clinical care. This profound treatment gap – the mismatch between community need and clinical care – perpetuates our city’s escalating opioid crisis. Barriers to addiction treatment are well established and range from patient centered issues, such as denial and privacy concerns, to physicians’ fears of drug diversion and lack of counseling support. At the same time, evidence based approaches to contain the opioid crisis are also well defined, and comprise 7 broad domains: 1) prescribing guidelines, 2) prescription drug monitoring programs, 3) pharmacy benefit managers and pharmacies, 4) engineering strategies, 5) overdose education and naloxone distribution (OEND) programs, 6) addiction treatment, and 7) community-based prevention (Johns Hopkins Bloomberg School of Public Health, 2015). Clinical providers (i.e. MDs, DOs, NPs, and PAs) play a central role in the effective implementation of these approaches, yet most US healthcare providers lack formal clinical training in addiction care. Not surprisingly, medication-assisted treatment (MAT) for opioid use disorders is widely underutilized or even unavailable in communities throughout New York City. The consequences of limited access to treatment are especially evident on Staten Island and the Bronx, the epicenters of NYC’s opioid epidemic. Based on recent NYCDOH epidemiological data, opioid overdose death rates in these regions is over two-fold higher than rates in the rest of the city. Expanding access to addiction treatment in these high-risk communities is an urgent need. Northwell Health – Staten Island University Hospital (SIUH), in conjunction with the Staten Island Performing Provider System (SI PPS), took up the call to deliver innovative and effective solutions for Staten Islanders.
In January 2016, Northwell Health – SIUH launched the Ancillary Withdrawal Management (AWM) Program to offer essential resources and treatment options for addiction care. The program is located on the SIUH South site, and embedded within an entire continuum of addiction services. At SIUH South, we have a comprehensive outpatient substance use disorders clinic, a methadone maintenance treatment program clinic, a 23-bed inpatient detoxification unit (the only such unit on Staten Island), as well as an inpatient drug rehabilitation unit. The AWM program serves many purposes including outpatient detoxification, MAT maintenance, recovery counseling, and acts as a vital conduit to comprehensive mental health services and primary medical care. To date, the Ancillary Withdrawal Management Program has welcomed over 550 new patients through its doors, of which over 90% were struggling with an opioid use disorder. A significant portion of patients transition to maintenance management as well as engage in an array of recovery efforts within the clinic such as recovery process groups and vocational services.
The AWM program was uniquely constructed with the specific intent to diminish barriers to addiction care. This begins with easing the process of accessing care itself. The facility operates as a walk-in clinic for the community, and also accepts referrals from inpatient units, outpatient clinics and emergency departments. In order to support the varied needs of such a patient flow, the AWM program developed a dynamic team that consists of the following: an addiction medicine specialist, an addiction psychiatrist, a physician’s assistant with a strong background in pain management, two masters-level mental health counselors, a registered nurse, and a clinic registrar. Each member of the team works closely with patients to address an array of complex social, clinical, and recovery needs. When asked about the experience of AWM, a patient commented, “I was lost before walking through these doors, I could never have imagined the connection I feel to my counselor and safety I feel here. For the first time, in such a long time, I have hope.”
From the point of entry all patients complete a detailed medical and psychosocial assessment. Patients may be offered treatment options for short-term detoxification or maintenance treatment. MAT for opioid use disorders, such a buprenorphine or naltrexone, can be initiated from day 1. All patients are also offered overdose education and naloxone training. The AWM program is an effective setting for naloxone kit distribution. The AWM clinic relies on home-induction strategies, which increases the flexibility of MAT care, but also retains the capacity for daily follow-up and monitoring if clinically indicated. The clinic is open on weekdays from 8-5 and in the process of expanding evening and weekend hours. In turn, as patients stabilize, their treatment plans evolve to address longitudinal goals. On the other hand, if a patient is not responding to treatment options then they are swiftly connected to higher levels of care within SIUH’s addiction or mental health services. Over 125 patients are actively engaged in continuing care with the SIUH AWM clinic. The robust response to the availability of the AWM program highlights the transformative potential of increasing accessibility of care in areas of unmet need.
As the US opioid crisis evolves, the potential for catastrophe accelerates. In 2016, the number of fatal opioid overdoses in NYC jumped to 1,200, which was a 60% increase from 2015. Bridging treatment gaps by increasing access to addiction treatment is an essential component of ending NYC’s drug epidemic. Northwell Health – Staten Island University Hospital is committed to bringing about positive sustainable change for the community it serves.
If you need more information about Northwell Health SIUH Ancillary Withdrawal Management Program, please call 718-226-2824/2812 or Central Intake at 2800 or visit our service locator website at www.northwell.edu.