Rewrite the Script launches Addiction Consult Team (ACT) service

June 22, 2021  //  FOUND IN: Our Employees,
Two women and a man stand next to each other in a hallway wearing masks.
ACT team members, L-R: Emily McCall, M.S.W., Michelle Brauninger, peer recovery coach, and Nathan Menke, M.D.

Rewrite the Script, a group of physicians, nurses, therapists and other volunteers dedicated to fighting the opioid crisis, have hit another major milestone with this month’s launch of a new Addiction Consult Team (ACT) service.

ACT’s interdisciplinary team has already begun working with acute care patients (both adult and pediatric) within emergency departments and inpatient facilities to help appropriately treat substance use disorder (SUD) — including opioid use disorder (OUD) — and connect patients with resources to minimize harm and support recovery.

With opioid overdoses increasing 20% during 2020, this launch couldn’t come soon enough for the Rewrite the Script team who first began envisioning the project back in November 2018. Despite delays due to COVID-19, they managed to implement part of the team for an early launch in April, successfully supporting more than 50 patients before the full team launched on June 10.

How It works

ACT will collaborate with the patient’s home care team to encourage appropriate medication use, connect patients with outpatient services, educate staff and trainees on evidence-based addiction treatment, and reduce stigma toward patients with addiction. Initially, ACT will be available in person weekdays, 8 a.m. – 4 p.m., and consists of:

  • A physician with addiction expertise who assesses the patient to create a treatment plan.
  • A peer recovery coach (someone with lived experience in recovery) who will meet, engage and follow up with patients to provide support throughout treatment and recovery.
  • A social worker to coordinate outpatient follow-up appointments.
  • A dedicated nurse navigator to coordinate patient care with primary care providers and ensure correct medication dosing and adherence..
  • A clinical pharmacist to assist with complex medication management.

The team will also work closely with other interrelated services including psych consult liaisons, acute pain service and palliative care.

Discovering opportunities to make a difference

When the Rewrite the Script team took a deep dive into the data surrounding opioid addiction and other SUD cases at Michigan Medicine, they discovered a lot of opportunities to make a difference. 

“We discovered that over a 12-month period during 2019, there were almost 600 emergency department (ED) visits related to overdose or SUD issues, with 200 involving opioids,” said Fiona Linn, strategic advisor to the chief medical officer and project lead for the SUD implementation. “However, when we broadened our view to consider patients visiting our ED and/or being admitted to the hospital for other reasons, but who have some history of substance use issues, there were closer to 11,000 visits (3,000 opioid-related).

“That represents 11,000 opportunities to potentially engage with patients around their substance use, and how it is impacting their overall health and other medical care.”

Research shows that patients who engage with an inpatient SUD consult service while in the hospital are twice as likely to engage in outpatient treatment.

Further, those patients with opioid use disorder who engage in outpatient medication-based treatment are 2.5 times less likely to return to the hospital.

Breaking down the stigma

This research is proving true, according to ACT team members who have already made an impact through the program.

“We have definitely been able to make a difference in our first few months,” said Emily McCall, M.S.W., M.M., a social worker with the program. “For example, a patient came into the ED due to their substance use and had been seen at multiple local hospitals for similar issues. We had a great talk and the patient thanked me for taking the time to really listen and for treat them like a person. Too often we hear about patients with substance use being treated disrespectfully in health care. There is so much value to taking the time to treat everyone with dignity and respect.”

Reducing the stigma attached to SUD is one of the team’s many challenges. Another critical hurdle will be providing these critical resources and support to providers so they can become comfortable and feel confident in caring for those with SUD.

“Without addressing a patient’s pain and addiction, we are often not allowing them the comfort and care needed to successfully complete other treatments,” said Pooja Lagisetty, M.D., M.Sc., assistant professor of internal medicine and one of the physicians who helped design the ACT. “By consulting the ACT team, we will hopefully make it easier to accomplish the same shared goal of providing the best possible evidence-based care. Plus, we know that every time a patient is not treated for their addiction, it is truly a missed opportunity to engage in care. 

“These missed opportunities unfortunately are often deadly in the form of overdoses or even criminalization. From an equity perspective, it is our job to provide the same level of care for pain and addiction that we do for other medical diseases.”

The ACT service is just one initiative within the three-pronged approach of Rewrite the Script’s war on the opioid crisis. The team is also focused on promoting the use of pain profiles, which capture the patients “pain story” to facilitate pain treatment across the care and life continuum, and expanding non-pharmacologic options for pain including acupuncture, healing touch, aromatherapy, art/music, guided imagery, mindfulness and a greater incorporation of movement.

Stay tuned for other Headlines articles about progress in these areas.