Sentara helps to reduce Opioid Use Disorder through outpatient therapy

Sentara Healthcare is offering a new opportunity for patients with Opioid Use Disorder (OUD) to connect with outpatient treatment programs while using buprenorphine to sustain them. Buprenorphine eases withdrawal symptoms and blocks the ability of other opioids, including heroin, to cause euphoria. Unlike methadone, taking more will not increase its effects. It helps patients with OUD maintain sobriety while seeking treatment.

The new program is called the Sentara Opioid Bridge to Recovery, or SOBR. Emergency department physicians and other providers licensed to prescribe narcotics are now able to prescribe buprenorphine. ER staff will make appointments with local therapy programs and Community Services Boards (CSBs) before patients leave the ER. For patients seen after hours, local CSBs, Behavioral Health navigators with Optima Health and other providers will receive secure patient information electronically and follow up the next business day.

 “This is a huge step forward in helping reduce opioid dependence,” says Carol McCammon, an ER doctor with Emergency Physicians of Tidewater and president of the medical staff at Sentara Princess Anne Hospital, who championed the SOBR concept. “SOBR gives us an opportunity to break the cycle of overdose and rescue and connect OUD patients with community-based treatment.”

 Until recently, providers wanting to prescribe buprenorphine had to take an online training course and apply for a federal waiver. Advocates considered those requirements an unnecessary barrier to treatment. The Consolidated Appropriations Act, 2023 removed the waiver requirement.

“More than 200 of our providers took the waiver course before the government lifted the requirement,” says Nedra Moncrief-Craig, system director for Sentara behavioral health services. “Now, all providers licensed to prescribe narcotics have an opportunity to make a lasting difference for our patients with OUD.  Dr. McCammon is a great advocate, and it’s gratifying to work with her on the SOBR project.”

 =SOBR is being piloted in the ERs at Sentara Virginia Beach General Hospital and Sentara Princess Anne Hospital in Virginia Beach until April 24th.  Starting April 25th, SOBR will come online at other Sentara hospitals and free-standing ERs in Hampton Roads. Sentara facilities in the Blue Ridge region will begin the program in the 3rd quarter. Facilities in Northern Virginia, the Halifax area and Elizabeth City, NC will get the program in the 4th quarter.

Sentara opioid initiatives help reduce OUD

Enhanced Recovery After Surgery (ERAS) – This opioid-reducing program, started in 2018, has appropriate patients prepare for surgery by adopting a healthy lifestyle in the weeks prior, quitting tobacco, and exercising as they are able. Non-opioid IV pain medications are given during surgery prep, so they are already working when the patient wakes up and are given as needed post-surgery. Patients are up and walking the next day and eating solid food, leading to earlier discharges and fewer infections.

Speedy access to addiction treatment - Optima Health, a Sentara-owned health plan, implemented a Medicaid Managed Care benefit called Addiction Recovery & Treatment Services (ARTS) in 2017 for all Optima Family Care and Optima Community Care members. Case managers help ensure access to addiction treatment the same day they apply or within 24 hours.

Optima health reduced opioid prescribing by 49% - Optima Health has focused on writing fewer prescriptions for lower doses of opioids. In March of 2019, Optima Health reported:

• 30 percent fewer members with an opioid prescription.
• 43 percent reduction in prescriptions written.
• 2.5 million fewer opioid pills prescribed.

A driving concept in this initiative is using opioids only as a last resort in pain management.

Outpatient Services - Sentara Behavioral Health Services provides outpatient treatment programs, including an intensive outpatient program (IOP) and partial hospitalization program (PHP) at several hospitals in Hampton Roads and other regions we serve. The Intensive Outpatient Program (IOP) is designed for patients with chemical dependency and substance addiction who are beginning recovery. The program allows patients to receive help and therapy with minimal disruption to their daily lives. The Partial Hospitalization Program (PHP) is designed for anyone experiencing severe depression and having difficulty maintaining day-to-day functioning, who would benefit from a structured, protective environment but do not need inpatient hospitalization.

Safe Prescribing guidelines in ERs - In 2016, all Sentara emergency departments adopted safe prescribing guidelines recommended by the CDC and the American Hospital Association.

• We will not administer intravenous or intramuscular opioids for relief of chronic pain.
• We will not provide replacement prescriptions for prescription opioids.
• We will not prescribe long-acting opioids such as oxycodone, extended-release morphine, methadone, buprenorphine, hydromorphone or fentanyl patches.
• We will not prescribe more than 20 opioid pills.

Patient Contracts - Sentara Medical Group physicians sign contracts with pain patients who pledge to take opioids as prescribed, use only one pharmacy and, if using an ER, to alert the care team that they have a pain prescription. They also agree to periodic urine screens. Violating the contract can lead to dismissal from the practice. OTC medications are always a first course of treatment. Opioids are the last.