MUSC Health team helps hospitalized patients get addiction treatment

Allison Smith, M.D., hates to see addiction not only take over patients’ lives but also cause life-threatening health problems. “They come in because they're sick, so critically ill, they are often at risk of dying.”

Case in point: Lauren, a young woman struggling with heroin use, who arrived at University Hospital with a blood infection. She got it when unhealthy bacteria entered her body through her long-term use of needles. The infection led to dangerous inflammation in her heart, a life-threatening condition called endocarditis.

Lauren not only needed surgery and a pacemaker at just 29 years old, she also needed help quitting the drug that almost killed her. She found that help through Smith’s team, a group that includes a peer recovery coach and a care coordinator who are passionate about helping people struggling with drug and alcohol issues get addiction treatment while they’re still in the hospital. You can read Lauren’s first-person account here.

Smith said getting patients such as Lauren on evidence-based medications that treat opioid use disorder is essential. The medications help cut back on cravings and withdrawal symptoms and can allow them to return to their normal lives. They also decrease the risk of overdoses and death. “It is critical to not only treat the medical consequences of substance use, like endocarditis, but treat the underlying disease of addiction to prevent future morbidity.”

Smith’s program, the only one in the Charleston area that reaches patients while they’re hospitalized for major health issues related to addiction, is seeing plenty of success. In its first year, the team started more than 70 patients on medications for treating substance use disorders. These medications include buprenorphine and methadone for opioid addiction and naltrexone for alcohol addiction.

“We're seeing that a really high percentage of people who start these medications while in the hospital stay in treatment after discharge. We call them at a month, three months, six months and are tracking if they're still in treatment. We were seeing 61% were still in treatment at 30 days. At six months it was 44%. That's higher compared to other studies.”

The program builds on the success of a similar one in the Emergency Department at MUSC Health that focused on fast-access to treatment for opioid addiction. Peer recovery coach Patrick Harmon has worked for both programs. He’s now on Smith’s team, continuing to use his own experience with addiction to bond with patients.

“Most of the time when I introduce myself and I say that I am a person in long-term recovery, most patients usually let their guard down a little bit at that point, and they say, ‘OK, well I'm open to hear what you have to share with me,’” Harmon said.

As a person in recovery, he knows how challenging what he’s asking them to do — try medication to help them quit using drugs or alcohol — really is. “It took me multiple attempts,” Harmon said.

 

“I had a friend, one of my childhood friends, in adulthood had been an actively using addict, and I had not seen him for a while. The next time I saw him, he was different. And I said, ‘Hey, I haven't seen you for a while, man. Where you been?’ So he was like, ‘I went to rehab,’” Harmon said.

“It wasn't long after that that I picked up the phone book and was looking for something related to rehab. And I found a place that directed me to a detox. So I think really, running into that friend who had made some changes in his life was the seed being planted for me.”

He tries to plant that seed for patients in the hospital. Some are more than ready to give medications approved for treating addiction a try. Others aren’t. In those cases, he gives out his business card and a supportive message. “If you change your mind at any point, and you decide that you actually want to talk to someone about any substance use related challenges you might have, you can feel free to give me a call at any time.”

Smith, an assistant professor board certified in Addiction Psychiatry in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina, launched her program in 2021. Funding comes from the South Carolina Department of Alcohol and Other Drug Abuse Services’ State Opioid Response Grant for Development of Hospital-Based Addiction Services.

Smith calls her group the Addiction PMC team. P stands for peer, M for medications and C for complex care coordination. It has a statewide reach. “We’ve seen people from over 31 counties from South Carolina. We're not just serving the Charleston area. People come here to MUSC for a higher level of care and specialty care, especially if they need valve replacement surgery or other specialty treatment.”

She said providing that care, including addiction treatment and services, not only benefits the patients but also the health care system. Abstinence from drugs or alcohol cuts way back on future health risks and, most importantly, prevents overdoses and deaths.

Society benefits, too. “If people are in treatment and in recovery, they're able to rebuild families, restore relationships and reenter the workforce and the community,” Smith said.

“Addiction doesn't discriminate, and it's so important to make sure that we screen, identify and offer people life-saving treatment. The inpatient hospital setting is the perfect opportunity to accomplish that.”