Nashville's largest hospital is launching a part-time addiction clinic, so overdose victims have somewhere close to go after the emergency room. Vanderbilt University Medical Center's new "bridge clinic" began ramping up Friday.
An ER can become a revolving door for patients in active opioid addiction. After an overdose, they're revived and stabilized. At best, they get linked up with a treatment center in town. At worst, addiction psychiatrist Dave Marcovitz says, they're just given a phone number and sent on their way.
"And that wasn't just true at Vanderbilt," he says. "That was true everywhere around the country. And this is where we're trying to make inroads."
Vanderbilt's bridge clinic is modeled after programs at Massachusetts General and Yale New Haven Hospital. It allows patients to go straight into a three-month outpatient treatment program on campus, where they get assistance from buprenorphine medication, which reduces drug cravings.
And referrals from the ER are not required to make the usual commitments about avoiding illicit drugs altogether. Marcovitz says it signals a shift on campus to more of a "harm reduction mindset."
"The bottom line is we want to make addiction care synonymous with medical care," Marcovitz says.
The clinic will start out at one day a week. To further bridge the gap between the ER and treatment, Vanderbilt emergency physicians will start prescribing buprenorphine July 1.
Only recently have emergency physicians started prescribing drug treatment medication, though it's still relegated mostly to California and the Northeast. But research is finding that patients are much more likely to stick with treatment if it starts in the ER, rather than after release.
Running its own clinic makes more financial sense than in recent years, because TennCare now has more generous coverage for medication-assisted treatment, Marcovitz says.
Vanderbilt also has many patients with opioid addictions who need treatment for a dangerous heart infection. But they end up with extended stays merely to receive antibiotics through a central line, which most people could get in an outpatient setting. Because of their history, they're not released until the central line comes out, since it could also be used for illicit drugs.
"If we can make sure these patients don’t fall through the cracks, maybe we can make it safer for them to leave the hospital," Marcovitz says, suggesting the bridge clinic may also help cut down on hospital readmissions.