The opioid crisis shocked America’s health care system.
Historically, hospitals regarded addiction as a “behavioral” issue, not a medical one, and, therefore, not their bailiwick. Patients who had overdosed were stabilized, but then shown the door.
Overwhelmed by the crisis, hospitals adopted a patchwork of ineffective and incoherent strategies that are seen as part of the problem now killing close to 50,000 people a year in the United States.
“At some hospitals, there’s follow-up within a few days,”says Caleb Alexander, M.D., “while, at others, it’s the wild, wild west, with patients being given a handful of phone numbers and sent on their way. There are huge gaps in the system, and patients are getting lost.” Alexander is co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.
The chaos explains why Navdeep Kang, director of operations for behavioral health services at Mercy Health-Cincinnati, has stood out. Kang, who has a doctorate in psychology from Cincinnati’s Xavier University, is part of a team of doctors and administrators who’ve pushed Mercy emergency room physicians to treat people with addiction disorders like heart patients, offering them treatment drugs and prompt placement in a rehab center. (Mercy Health-Cincinnati, with five hospitals, is part of the wider Mercy Health system, which operates 23 hospitals and numerous clinics across Ohio and northern Kentucky. The Mercy Health system is scheduled to merge this fall with Bon Secours, a Maryland-based Catholic health system.)
“What if your mom had cancer, and I told you that she had a one in ten chance of getting treatment?”—Caleb Alexander, MD
“What makes [Kang’s] work so striking is that it really challenges some of the prevailing norms and stereotypes about addiction,” says Alexander. “Opioid addiction is a disease that deserves care. What if your mom had cancer and I told you that she had a one in ten chance of getting treatment?”
Hamilton County, where Kang’s hospital is located, has seen a 34 percent drop in overdose deaths this year, a 36 percent decrease in overdose visits to the emergency room, and a 50 percent drop in patients entering treatment for opioid use disorder. That’s not all Kang’s doing, of course. A variety of interventions seem to be helping. A 375 percent jump in the distribution of Narcan, a form of the naloxone overdose reversal drug, has likely contributed to the drop in overdose fatalities, for instance.
Kang’s contribution, however—guaranteeing treatment and helping to communicate with local rehab centers—is considered so innovative that he was named a 2018 Obama Foundation fellow. The award provides no money, but furnishes a platform of writing and speaking engagements to preach his approaches.
Over 20,000 people from 191 countries applied for the fellowship. The foundation chose Kang as one its 20 winners because his “collaborative” approach is “revolutionizing” the treatment of addiction, says Julien Martinez, a foundation spokesperson. “By coordinating services and providing immediate treatment,” Mercy is “saving lives and giving hope to those who are working to end this health crisis,” he said.
To be sure, there are some challenges with Kang’s approach. It’s expensive, for one. Also, it can be hard to sell to health officials worried about getting scammed by “pill seekers”—patients describing bogus symptoms to trick doctors into prescribing opioid medications.
And it may not work everywhere. “If you’re in a rural county in West Virginia or Kansas, without a rehab center nearby, it’s tricky to send somebody out into the world with seven days of treatment drugs,” says Alexander. (The most commonly prescribed treatment drug, buprenorphine, is itself an opioid, and can be abused or diverted.)
Mercy Health has set up drop boxes for the disposal of excessive medication, and a needle exchange in the parking lot, where people are encouraged to enroll in treatment.
Kang has contributed to a wider cultural change at Mercy, says Larry Graham, president of the Mercy institute where Kang works. For example, it has linked executive bonuses to hospital performance targets, such as prescribing fewer opiates, says Graham. It’s also set up drop boxes for the disposal of excessive medication, and a needle exchange in the parking lot, where people are encouraged to enroll in treatment.
In the emergency room at Mercy, doctors administer buprenorphine when appropriate, and coordinate with nearby rehab centers, which have access to Mercy’s health records. Mercy now has a secure text-messaging system that allows doctors to speak with each other about patients while preserving patient confidences, and permitting ER doctors to email addiction doctors and peer counselors for advice.
People with addiction disorders “need comprehensive care from the moment you walk in until you’re healed,” says Kang. At Mercy, people with addiction disorders—the word “addict” is verboten—“are treated as if they had any other health care condition,” he says. “It’s not a moral failing.”
The 37-year-old Kang, who is married with small kids, grew up in Cincinnati. His dad, a cancer researcher, had worked for the National Institute for Health, and then moved the family to Ohio to take a job with a private pharmaceutical company.
In 2014, after getting a doctorate in psychology, he started working in Mercy’s primary care unit in Cincinnati.
One day, he says, a woman came in seeking treatment for her addiction to opiates. The hospital found a center that had a two-week waiting time. But when Kang called a friend who ran a rehab center, the woman got an appointment the next day. The anecdote taught him that treatment slots were often available, but not being used.
Mercy does not “guarantee that someone will get specific drugs when they get a specific service,” says Kang. “No area of medicine does that because it could set up the treating provider to fail. Instead, we train and equip the treating providers to make an accurate assessment and offer the appropriate intervention.”
Kang believes that addiction is forged by either genetics and experiences in youth that impact developing brains, he says. “If you’re educated that the way to cope with anxiety is to kill a six pack,” that will create a more addictive personality “than if your coping mechanism is yoga and meditation,” he says. “Your experiences structure your brain.”
Besides trying to help people overcome addiction, Mercy has also stepped up its use of local pain treatments, like Lidocaine, instead of general, opioid painkillers like Percocet. In addition, it encourages non-pharmaceutical forms of pain management, including exercise and even music therapy.
One concern is that, because hospitals haven’t been prepared to offer full treatment, “even people who wanted to get into recovery would have to resort to saying they were suicidal” to get treatment, says Kang.
“Mercy Health has taken away that pretext by offering treatment to anyone willing to enter recovery.”