340B Hospitals Are Key Part of National Response to Opioid Epidemic
WASHINGTON, D.C.— Hospitals participating in the 340B drug pricing program are among the leaders addressing the ongoing opioid epidemic in the U.S. Efforts include community education, changes in prescribing patterns, prescription drug take-back programs, and treatment to reverse overdoses.
340B Health released a report titled, “340B Hospitals on the Front Lines of Addressing the U.S. Opioid Epidemic.” The report profiles six 340B hospitals in different parts of the country, based on interviews with hospital leaders. The hospitals range in size from two 25-bed critical access hospitals in rural Minnesota to a 700-bed facility in Cleveland.
340B hospitals often work with local community organizations and law enforcement agencies to create initiatives that reach people where they live, work, and pray. Hospital leaders reported using 340B program savings to support many of their initiatives. Many noted that the absence or limitation of 340B savings would force them either to find funding elsewhere or curtail some or all of their efforts.
“340B hospitals often are at the forefront of addressing national health challenges,” said 340B Health President and Chief Executive Officer Maureen Testoni. “While there is no one-size-fits-all approach to confronting the opioid epidemic, we see how these six hospitals have developed successful approaches tailored to the needs of their communities.”
While many of the results of these efforts are encouraging, hospital leaders agree there is much more work to do to reverse the national epidemic.
According to the Centers for Disease Control and Prevention (CDC), in 2017 there were more than 70,000 drug overdose deaths in the U.S., the highest figure for any single year in U.S. history. The CDC also found that the increase in drug overdose deaths was the primary cause behind the drop in U.S. life expectancy in 2017, making that year the third in a row in which life expectancy fell or remained flat.
Boston Medical Center (BMC), a 399-bed disproportionate share (DSH) hospital, launched the Grayken Center for Addiction in 2017 to coordinate and lead all its efforts to address opioids. BMC distributes naloxone kits and provides training to emergency medical technician crews, Boston University campus police and dormitory supervisors, and people with substance use disorders as well as their family and friends. BMC emergency clinicians are leading the way in initiating patients on medication for addiction treatment (MAT), using a nurse manager model that has been adopted by many localities across the nation.
CHI St. Gabriel’s Health, in Little Falls, Minnesota, is a 25-bed critical access hospital (CAH) in a rural community that saw signs of an opioid epidemic that many in the community didn’t know were there. They instituted a program aimed at changing prescribing habits and limiting access to opioids as well as addressing hospice care, nursing home care, treatment options, patient and community education, law enforcement, and the cost of treatment for opioid use disorder. A Controlled Substance Care Team that includes physicians, social workers, a pharmacist, and a nurse works in the community to prevent and treat opioid misuse. Pain contracts between patients and their doctors help opioid users to be weaned from opioid use. Patients must agree to subject themselves to random urine and blood screens to remain in the program. The initiative has helped dramatically reduce the number of opiate prescriptions written by the hospital’s physicians. More than 340 patients have been weaned from their reliance on narcotic medications, and the number of pills prescribed dropped from 38,000 in January 2015 to 21,500 in January 2018.
FirstLight Health System is a 25-bed critical access hospital in Mora, Minnesota, serving an extensive rural farming community in a four-county radius. Hospital leaders began seeing signs of opioid overuse and launched a community education program, working proactively with local law enforcement and community leaders to prevent the epidemic from affecting more lives in their community. The hospital’s pharmacy director traveled to local church gatherings, Lions Club meetings, and other community groups and schools. FirstLight also developed take-back days in the community so residents could return any unused or extra opioids in the household, thereby reducing the risk for opioid-related incidents. A recent addition is a medication-assisted treatment (MAT) program, which currently has 15 active patients.
MetroHealth System, a 700-bed DSH hospital in Cleveland that serves northeastern Ohio, has seen the number of opiate-related deaths in the region surge from 370 in 2015 to 727 in 2017, making it one of the hardest-hit areas of the country. MetroHealth has taken a multifaceted approach, including prevention, treatment, and close collaboration with organizations throughout the county. Its Project DAWN (Deaths Avoided with Naloxone) pilot project provides walk-in services to help people with opioid use disorder, family, and friends identify risk factors for an opioid overdose and learn how to respond to such an emergency. People enrolled in the program receive free naloxone kits that contain two vials of the life-saving medication. A community-based “quick response team,” which also includes social workers and local police, goes to an overdose victim’s home within seven days of the incident to help connect them to treatment and provide a free naloxone kit. MetroHealth has increased staff and built infrastructure to direct these efforts, including creating the Office of Opioid Safety, and 14 employees are solely dedicated to opioid treatment and prevention. Full-time educators work with providers on such issues as MAT, interpreting toxicology screens, and weaning patients off opioids. By the end of 2018, Project DAWN estimated it will have distributed 12,000 naloxone kits since its inception and reversed more than 1,800 overdoses with these kits.
Riverside Health System in Newport News, Virginia, is a 392-bed DSH hospital serving the peninsula region in the southeastern portion of the state. A major focus of its opioid program is on pregnant and parenting women. The region also has experienced an increase in HIV-related illness as well as serious injection-related infections. The hospital’s South-Eastern Family Project offers comprehensive day and residential treatment to women with opioid use disorders, providing a stable and secure environment where women and their children can stay together throughout the course of the treatment they need to get and stay healthy. Riverside’s neonatal intensive care unit (NICU) provides specialized services to the increasing number of infants born to area mothers with opioid use disorders. The system offers an inpatient antibiotic therapy program for patients whose use of injectable drugs has resulted in serious infections, a program that integrates behavioral health assistance. Riverside also provides naloxone kits to local law enforcement agencies who might best be equipped to respond in such emergencies.
Wake Forest Baptist Health in Winston Salem, North Carolina, is an 800-bed DSH hospital serving rural communities in northern North Carolina and southern Virginia. The hospital’s staff saw a surge in opioid-related deaths beginning in the early 2000s. The multi-faceted response includes providing naloxone kits to at-risk patients and community members, working with the system’s medical staff to reduce the number and length of opioid prescriptions, providing drug “take-back” programs in every one of its pharmacies, and working with local pharmacists to help identify people who may be at risk for opioid use disorder.
Contact: Richard Sorian at richard.sorian@340bhealth.org or 202-536-2285.