“Please don’t discharge him,” pleaded the mother of a 16-year-old patient who had overdosed from prescription opioids and landed in my care in the intensive care unit (ICU). As a critical care physician, most patients and families can’t wait to leave my unit. This patient was physically fine to leave the ICU, but his parents and I knew that the underlying issue that brought him into the hospital – his substance use disorder – had not been addressed. I had no choice but to send him on his way. That was nearly 15 years ago, at what I thought was the height of the drug epidemic.
Today, an estimated 107,000 Americans died of drug overdoses in 2021, according to provisional estimates just released by the Centers for Disease Control and Prevention. According to the 2020 National Survey on Drug Use and Health, only 6.5% of the 41.1 million people struggling with substance use disorder received the necessary treatment during the previous year. This narrative is all too common.
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Yet, we find our country in the midst of a worsening opioid epidemic and same state of disarray and disjointed care that we were in decades ago. This is because of the three main causes of epidemic – physical, mental, and economic pain. Physically, some physicians have traditionally overprescribed opioid medications to their patients, driven by pharmaceutical company messaging. Mental factors include the increase in the prevalence of mental health conditions, fueled by the isolation, stress and financial strain of the Covid-19 pandemic. Lastly, the widening wealth gap plays a role because research shows that those who struggle financially are more likely to turn to substance use.
Since we know the fundamental causes of the opioid epidemic, why are we still here? It all centers around stigma. Stigma drives lack of access to evidence-based treatments. Imagine if only 10% of patients that suffered a heart attack received access to definitive evidence-based care – there would be an outrage. That’s what currently happens to individuals who overdose on opioids. Further, stigma drives lack of parity. While the Mental Health Parity and Addiction Equity Act went into effect 15 years ago, requiring insurers to cover behavioral health benefits at the same level as physical health benefits, a recent report found this law has not been enforced. Finally, stigma drives a lack of connectivity. Clinicians often cannot share life-saving behavioral health data with other providers – whether they practice behavioral or physical health medicine – furthering the lack of care coordination.
While it’s easy to look at this problem as insurmountable, there are solutions if we work together. First, we must meet individuals where they are and shift the focus to prevention. That work often begins in our homes or physicians’ offices by first screening for and identifying the behavioral health needs of ourselves or our loved ones. With free assessment tools, like the Addiction Treatment Needs Assessment, clinicians and consumers alike can assess the needs of a loved one or their patient for substance use disorder treatment to support them in finding the right level of evidence-based care. In addition, with specific tools and platforms that integrate into provider’s electronic health records, insights into an individual’s holistic medical and behavioral health history and analytics about substance use history, providers can quickly and effectively understand an individual’s risk of overdosing, helping them make the right decisions for their individualized care needs.
Building on an in-depth understanding of an individual’s needs, we must then turn our attention to identifying the appropriate type and level of evidence-based treatment. For example, if a physician determines that one of their patients is currently struggling with substance use disorder, it’s imperative the physician know how to help their patient. However, in our current healthcare system, that’s easier said than done. Providers generally don’t have insight into available treatment options for patients, such as inpatient and outpatient treatment centers and providers focused on mental health and substance use disorder. Therefore, providers cannot refer patients to the right care, which results in major barriers to appropriate and timely care. Today, telehealth makes up 36% of mental health and substance use visits, while much of physical health has returned to in-person care.
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Much of these evidence-based treatments and access to necessary patient data rely on care coordination. Without care coordination, our country’s healthcare system will continue to operate in silos separating our physical beings from our mental ones. Integrating both physical and mental health information into electronic medical records and other regularly used workflows at the point of care is vital to ensuring primary care providers and clinicians across different specialties can make timely and appropriate referrals and care decisions. For example, the use of e-notifications can provide real-time alerts to providers when their patient is admitted, discharged, or transferred from a hospital. This means a behavioral health or primary care provider can help facilitate follow-up care immediately. Without this type of integration, a patient’s care team simply cannot communicate and provide their patients with the right kind of care at the right time.
Fortunately, we’re starting to make progress. In July, people will be able to call 988, akin to 911, if they’re suffering from a behavioral health emergency. Further, Congress and the Biden administration have recently funded behavioral health reform and introduced bipartisan legislation. Using this momentum, we can continue this important work. By understanding the root causes of substance use disorder, destigmatizing mental healthcare, and working together to improve access to treatment and care coordination, we can more fully support an individual’s care needs before it’s too late.
Photo: Moussa81, Getty Images
Nishi Rawat, MD, MBA, began her healthcare career in 2002 as an emergency medicine and critical care physician, treating a significant number of patients suffering from SUD. As a healthcare faculty member and researcher, she led quality measure development and implementation at Johns Hopkins Armstrong Institute for Patient Safety and Quality.
Using her previous years of frontline medical care experience and passion to improve care delivery, in 2015 Dr. Rawat founded and served as lead technologist for OpenBeds®, a company dedicated to improving access to mental health and SUD treatment. Following the company’s acquisition by Appriss Health (now Bamboo Health), a healthcare technology solutions company focused on fostering care collaboration and providing information and actionable insights across the entire continuum of care, Dr. Rawat continues to lead the OpenBeds® solution and behavioral health strategy as Chief Clinical Officer at Bamboo Health.
