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At Opioid Crisis Epicenter, WVU Medicine Blazes Trail

October 26, 2023
Emily Schweich

When James Berry, DO, director of addictions at association member WVU Medicine’s Rockefeller Neuroscience Institute, in Morgantown, W.Va., first joined the health system in 2002, he had no idea the state was on the brink of becoming a national epicenter for opioid use disorder (OUD).

“We were on the cusp of a national addiction epidemic, the likes of which we had never seen before,” notes Berry.

Within a matter of two years, the hospital system saw a clear “tsunami” of patients with OUD, and the public health crisis continues to mount. The number of fatal opioid overdoses nationwide increased sixfold from 1999 to 2021 and increased by 16 percent between 2020 and 2021 alone. Today, West Virginia has the highest drug mortality rate in the country.

“We just became inundated with people who were desperate for help,” he says.

Health system leaders realized treating one patient at a time was not sustainable to meet the demand, which inspired the Comprehensive Opioid Addiction Treatment (COAT) model, a group-based treatment model in which 10 patients at a time share 30-minute medical visits, followed by group therapy sessions.

Patients who are evaluated and referred to the program have access to medication-assisted treatment, which offers medications, including buprenorphine/naloxone (Suboxone), naltrexone, and Vivitrol, that work to manage cravings, eliminate withdrawal, and protect against overdose. Medical prescribers work with patients to determine the right medication and dosage.

Participants also share group-based sessions with medical assistants, case managers, and a clinical therapist. Clinicians also recommend peer support meetings and individual therapy following the sessions.

Sessions vary by level and type of needs, including a beginner group, an intermediate group, an intensive group, and a group designed to mitigate the clinical needs of pregnant and postpartum patients.

Pairing therapy with medication management helps target the underlying mental health conditions often tied with OUD, Berry says.

“We were able to address not just the medical part with the medicine, but also the psychosocial [part] with the group therapy,” he says.

Ensuring providers receive proper education to treat those with substance use disorder and understand the psychiatric aspect of the condition is a key mission at WVU Medicine.

“The workforce shortage is a huge problem across the United States and even more acute in rural areas like West Virginia,” Berry says. “We just simply don’t have the number of providers.”

To bolster the health care workforce, the health system operates an addictions medicine fellowship, founded in 2018, as well as a board-eligible addictions psychiatry fellowship, which includes an extra year of training for psychiatrists and other medical disciplines. WVU Medicine fills two positions each year with resident applicants from its psychiatry program.

West Virginia University Addiction Psychiatry Fellowship Addiction Medicine Fellowship

Addictions psychiatry fellows focus on psychopathology and psychotherapy, while addictions medicine fellows study comorbid medical problems, says Jeremy Herschler, MD, assistant professor at WVU School of Medicine. Both programs are based in the Department of Behavioral Medicine and Psychiatry. Past addiction medicine fellows, who are not psychiatrists, have praised this structure for giving them valuable psychiatric care training to treat patients with substance use disorder, says Fellowship Program Manager Wesley Foltz.

In addition to the COAT program, WVU Medicine provides inpatient care, residential treatment programs, and consultation services for patients with OUD. The health system also pioneered virtual care for its largely rural patient population.

The COVID-19 pandemic led to a national increase in relapse, as health systems were forced to shut down many in-person treatment options, but WVU Medicine’s existing virtual care foundation ensured patients did not face a gap in care. Providing virtual care for opioid treatment had equal outcomes compared with inpatient, in-person care, Berry says. Today, the system’s COAT program is 95 percent virtual and has seen a steady retention rate.

Investing in OUD treatment not only improves patient health but also helps reduce admissions and readmissions due to OUD and OUD-adjacent health needs.

“Certainly, the evidence is very clear that if you manage this well, then you will actually have better patient care, of course, but also you’re going to help with the health care costs,” says Berry.

As the opioid crisis grows, Berry urges all hospitals and health systems to prepare strategies for mitigating the issue in their communities.

“Every hospital should be aware that they have to take this seriously. There are still systems out there that think, ‘Well, this really isn’t a problem in our community,’ or it’s not something that should be a priority,” notes Berry. “It absolutely is.”

Essential Hospitals Institute, along with the CVS Health Foundation, is supporting essential hospitals’ work to increase access to OUD treatment, including by funding six hospitals’ work to build office-based addiction treatment programs and supporting 10 hospitals’ initiatives to understand how social drivers of health affect access to treatment.

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