The Warm Hand-Off

Apr 17, 2014

Doctors' offices and emergency departments sometimes struggle with how to help someone in active addiction. Where do you send them once they're stabilized? How do you talk to them about their addiction? Often they don't have the resources to arrange the next steps for these patients, and therein lies a missing link for addicts who seek medical help for one reason or another but don't get into treatment for the addiction that probably played a role in their seeking medical help in the first place.

Primary care doctors need a link to treatment
Example: Let's say someone who's addicted to prescription painkillers goes to the doctor for something else, a sore throat, and during the course of the visit it becomes clear to the doctor that this patient is clearly in trouble with drugs. But the doctor is a primary care specialist, not an addiction specialist, and has no connections with treatment facilities or knowledge of how best to talk to this patient or where to refer him. The doctor might suggest the patient seek help, provide a few phone numbers, and hope for the best. Then it's up to the patient to follow up, which, for someone deep in addiction, is often nearly impossible.

But what if there were someone the doctor could call to help diagnose the patient, and speak with him about treatment options, maybe even enroll him in a treatment program right then and there? That's what you call a "warm hand-off." And it's something state health agencies are working on instituting.

The state department of behavioral health has contracted with an agency to offer such phone consultations for doctors who have just such a patient in their office.

Connecting overdose survivors with addiction treatment, before they leave the hospital
They're also lining up "recovery coaches," people who are trained to work with addicts, to staff every Providence metro hospital around the clock on weekends. The idea is to approach people who've been brought in because of drug overdoses or are struggling with addiction before they leave the hospital, to have that conversation with them about what comes next: are you ready to get into treatment? Can we help you find a program or get you admitted to a residential facility right now?

Emergency room doctors and nurses can only do so much to help that patient, including saving his or her life and stabilizing him or her. But if there's no one around to help that patient navigate the options, he or she might just be discharged and wished well. Without some kind of intervention, the urge to use drugs again might be simply too powerful.

Let's hope these coaches can convince more than a few people to get the help they need, to provide that warm hand-off from emergency to the next level of treatment and recovery.