Project ID: 3.a.iv
Project Name:
Withdrawal Management
Project Description:
Development of Withdrawal Management (e.g., ambulatory detoxification, ancillary withdrawal services) capabilities and appropriate enhanced abstinence services within community-based addiction treatment programs
Project Chairs:
Joseph Sellers, MD, Bassett Medical Center
Mike Kettle, Conifer Park
Objective:
To develop withdrawal management services for substance use disorders (SUD) (ambulatory detoxification) within community-based addiction treatment programs that provide medical supervision and allow simultaneous or rapid transfer of stabilized patients into the associated SUD services, and to provide/link with care management services that will assist the stabilizing patient to address the life disruption related to the prior substance use.
Rationale and Relationship to Other Projects:
The majority of patients seeking inpatient detoxification services do not require the intensive monitoring and medication management available in the inpatient setting. These patients can be monitored in an outpatient program until stability is assured and, then, rapidly integrated into a co-located outpatient SUD program with PCP integrated team. Additionally, patients will be provided with care management services that will assist the stabilizing patient to organize medical, educational, legal, financial, social, family and childcare services in support of abstinence and improved function within the community. Care management can be provided as part of the SUD program or through a Health Home strongly linked to the SUD program if qualified for Health Home services. Such programs can address alcohol, sedative and opioid dependency as well as provide access to ongoing medication management treatment.
Core Components:
Steps to establish a program includes:
- Assessment of community need for this service to ensure location and services are coincident.
- Establishing referral relationships between community treatment programs and inpatient detoxification services with development of referral protocols.
- Addressing licensure/certification status of withdrawal management services based upon service category, i.e., ambulatory detoxification or ancillary withdrawal service.
- Identification/recruitment of a medical director, board certified in addiction medicine, with training and privileges for use of buprenorphine and buprenorphine/Naltrexone as well as familiarity with other withdrawal management agents.
- Identification of community providers approved for outpatient medication management of opioid addiction who agree to provide continued maintenance therapy and collaborate with the treatment program and care manager. These may include practices with collocated behavioral health services, opioid treatment programs or outpatient SUD clinics.
- Development of community-based withdrawal management (ambulatory detoxification) protocols based upon evidence based best practices and staff training approved by the OASAS medical director, if provided in an OASAS setting.
- Development of care management services within the SUD treatment program. For patients who qualify for Health Home services, development of a referral/shared care relationship with appropriate Health Homes. Care management will be expected to continue for the period the patient is in the treatment program. Care management may be enhanced by peer supports.
- Agreements with the Medicaid Managed Care organizations serving the affected population to provide coverage for the service array under this project.