Intermountain Healthcare, Volunteers of America, Utah, and Odyssey House are collaborating to help better meet the complex health and social needs of those living with opioid use disorders who also have an infectious disease. Their goal is to help patients transition from the hospital into addiction treatment more quickly.
Intermountain caregivers noticed a spike in the number of patients coming to the hospital with staph infections, or MRSA, from heroin use in 2014 – a potential byproduct of the opioid use disorder increase occurring in Utah and throughout the United States.
The infections usually require a PICC catheter line, or a peripherally inserted central catheter, to be placed in the patient’s arm or chest, to deliver antibiotics directly to the major veins in the heart. During this time, it’s critical to have medical providers monitor the patient. But for a patient who has an opioid use disorder with heroin or meth, withdrawals can be drastic, so there is an immediate need for them to enter treatment centers.
The United States and Utah are making progress in addressing the opioid crisis. However, an ongoing challenge in this effort is managing the increased incidence of blood-borne infections that accompany injection drug use. Such infections are a major cause of morbidity and mortality, as well as long and costly hospital stays.
Around 2014, Dr. Dean Mayer, hospitalist for Intermountain Healthcare, started to find an increase in the number of patients arriving in the hospital with injection-related infections from heroin and methamphetamine use.
For patients who have a concurrent substance use disorder, withdrawals are drastic and crippling to physical and behavioral health. Methadone or suboxone is typically used to help treat withdrawals, enabling people to enter substance use treatment centers.
Dr. Mayer witnessed these withdrawal symptoms and the negative effects that it had on the patients as well as the long and complicated hospital stays patients experienced.
“It was and has been critical to address and treat these withdrawals to achieve compliance from patients to engage in the treatment of their infections,” said Dr. Mayer.
Dr. Mayer and his Intermountain colleagues worked with faith-based non-profit Volunteers of America, Utah (VOAUT) to establish five inpatient rooms at the VOAUT offering this specialized treatment.
Now, patients are now transferred to immediate recovery for their substance use disorder while Intermountain HomeCare providers make visits to monitor and treat infections through the PICC lines.
Additionally, Intermountain has now been able to expand connections to recovery centers with support from Weber and Utah Counties.
"We are always pleased to partner with Intermountain Healthcare to create new opportunities for people to live healthier lives. We have seen participants both complete their medical treatment and increase motivation for living a life free of substance use," said Kathy Bray, president and CEO of Volunteers of America, Utah.
Odyssey House of Utah, a non-profit treatment center with 14 locations in the state, was able to expand the program by providing additional long-term residential support for patients who detoxed in VOAUT and then required further treatment for their substance use disorder.
“This innovative, collaborate approach is literally saving lives,” said Adam Cohen, Odyssey House CEO. “Working together, we are reducing the tragic and unnecessary deaths we’ve seen from the opioid epidemic.”
Jamie Shaw, 47, was one of the first patients with a PICC line who was able to utilize the program to get into treatment with Odyssey House.
Shaw said he was “running and gunning” for 20 years, abusing alcohol, cocaine, and methamphetamines. While under the influence of meth in May of last year he attempted suicide and was rushed to Intermountain Medical Center in Murray where doctors saved his life.
“I woke up in a lot of pain,” said Shaw, who regained consciousness after four days. “I cried a lot, but then I decided I was here for a reason.”
Shaw had developed an infection that was being treated with antibiotics through a PICC line and knew he needed treatment for his drug addiction, but only two centers would take a patient in residential care with a PICC line. One was in Washington state, the other was Odyssey House Utah, which was participating in the new program that had just been arranged with Intermountain.
He completed treatment at Odyssey, and today, continues with his aftercare program. He has a job, is clean and sober and said he is “generally happy while I continue to work out the kinks.”
If he wouldn’t have been able to get drug treatment while he was on the PICC line he said, “I would be dead now. It saved my life.”
Before this program, the chances that someone was able to successfully complete rehabilitation from a substance use disorder after a major infection was 10 percent or less. With this program, successful completion of infection treatment is close to 50 percent.
Prior to the program, patients had to wait until their PICC lines were removed and their infections addressed before they could get into recovery centers. That means that 90 percent would continue using drugs or die from their addiction and infection before getting into a recovery program.
The ability to receive treatment for substance use disorders is a first and major step towards recovery.
At treatment centers, patients are provided food and board, access to counseling groups, a case worker, and transportation to medical appointments. As part of the community collaboration, Intermountain Homecare also offers ongoing services like physical therapy and wound care.
“Intermountain’s mission is helping people live the healthiest lives possible. Meeting this mission and supporting people through treatment and recovery requires collaboration. We appreciate the opportunity to work with strong community partners to care for some of our most vulnerable community members,” said Mikelle Moore, Intermountain’s senior vice president and chief community health officer.