At HCMC, doctors pursue a new way to treat opioid addiction

Tonya Rainey estimates that she has cycled through hospital emergency rooms more than 50 times since she became addicted to opioids seven years ago.

Typically, Rainey, 45, who is homeless, has been given a small dose of medicine to ease her painful withdrawal symptoms and then sent back to the streets with a few numbers to call for chemical dependency treatment. Within hours, she is back to injecting heroin up to six times a day, which she says nearly took her life.

But when Rainey arrived at Hennepin County Medical Center early this month, vomiting and shaking from going two days without heroin, she had a drastically different experience: Addiction treatment specialists arrived at Rainey's bedside in the emergency room and spoke to her about a plan for recovery and getting off the streets. Rainey also was enrolled on the spot in HCMC's methadone program, which helps in reducing cravings and can alleviate excruciating withdrawal symptoms.

"They used to treat me like a nobody," Rainey said of her hospital care. "This was the first time that I felt like people really cared and believed me when I said that I'm ready to turn my life around."

Hennepin Healthcare, one of the state's largest hospital systems, is among a small but growing number of institutions nationwide that have begun initiating treatment for opioid addiction in the emergency room, where patients often have "hit bottom" and are more receptive to treatment. Clinicians are trying to fill a longstanding gap in the health care system and stem a rising tide of admissions to hospitals by people suffering from opioid addictions. Statewide, hospitalizations for substance abuse have soared 40 percent between 2010 and 2017, reaching nearly 10,000 admissions last year.

"One of the problems with addiction treatment is that it's generally been put on the patient to take care of on their own. We wouldn't tell someone with cancer or heart disease to go make an appointment and hope they get better," said Dr. James Miner, chief of emergency medicine at HCMC. "The goal now is to get people started on treatment and on the road to recovery right away."

Traditionally, doctors in busy urban emergency rooms like the one at HCMC have focused on stabilizing patients with urgent medical concerns and referring them elsewhere for follow-up care.

HCMC officials estimate that, on any given day, as many as a third of the hospital's 484 beds are occupied by people with substance-use problems. In the past, such patients could cycle through the emergency rooms without ever being seen by professionals who specialize in substance abuse or assessed for treatment programs in the community.

To break this cycle, HCMC in May became the first hospital in the state to embed licensed drug and alcohol counselors in its emergency room to evaluate people for treatment and to connect patients with substance-use problems to community providers.

And for the first time, emergency room physicians at HCMC have begun prescribing patients with several days' worth of a medication known as Suboxone that can ease withdrawal symptoms and suppress cravings. The medication acts as a bridge, helping patients to manage their symptoms until they are seen in an addiction treatment clinic for ongoing care.

HCMC physicians said they hope such efforts will reduce the number of people who suffer relapses after being discharged from the hospital. The Star Tribune in August reported dangerous delays in getting opioid-addiction medications into the hands of patients struggling with addiction.

Doctors across the state said patients would sometimes relapse because they could not access such drugs promptly and would go back to using heroin or prescription painkillers as a way to cope with painful withdrawal symptoms.

"This has the very real potential to save lives," said Kitty Earl-Torniainen, a physician assistant and specialist in addiction medicine at HCMC. "It allows for really vulnerable people to get help right away before the window of opportunity shuts."

The new consultation service could also result in significant cost savings by reducing ER admissions, hospital administrators said. According to HCMC, one year of treatment through the hospital's methadone program costs less than $5,500, while a single day in the hospital or a visit to the ER can cost more than $1,500.

"We need to be able to jump on that motivation for change immediately," said Emily Bastian, director of housing and case management at Avivo, a drug recovery center near downtown Minneapolis. "Hospitals routinely discharge patients who are still suffering from withdrawal, and the first thing that patients do is run out and get a chemical to relieve their pain."

For Rainey, the descent into addiction began seven years ago, when she was diagnosed with rheumatoid arthritis and was prescribed heavy doses of prescription painkillers for the often-crippling pain. Eventually, a friend taught her to shoot up heroin because it was cheaper than taking painkillers and the pain relief was more immediate, she said. Before long, Rainey said she was buying up to four $50 bags of heroin each day. The mother of eight children lost her home, became alienated from her family and began sleeping in public parks in south Minneapolis.

From her third-floor hospital room, Rainey recalled the day when she finally decided to seek help for her addiction. She was sitting outside her friend's tent at the large homeless camp along Hiawatha Avenue in south Minneapolis, waiting for a delivery of heroin.

When she arrived at HCMC, shaking and barely able to stand from withdrawal, a nurse quickly rushed her to an available hospital bed. Soon after, she was given medication to ease her pain, and a team of counselors and recovery specialists began talking to her about a treatment plan.

"I've never cried as much as I did that day," Rainey said, rubbing away tears. "There were so many people here [at HCMC] who had faith in me that I began to have faith in me, too."

This week, Rainey is expected to be discharged from HCMC after three weeks of round-the-clock care and counseling. She's now enrolled in an intensive outpatient treatment program, where she will attend therapy four times a week while receiving daily doses of methadone to manage her withdrawal symptoms.

Feeling healthy and clearheaded for the first time in months, Rainey said her first order of business upon leaving the hospital will be to visit her eight grandchildren in south Minneapolis.

"I feel ashamed that I've let my family down all these years," she said. "I've been away too long."