The Innovator Spotlight Series features thought-provoking discussions highlighting diverse areas of healthcare innovation. Today we’re continuing our conversation around how to address the opioid epidemic.
In the second of three interviews, we feature Emory Healthcare’s Dr. Justine Welsh, a child/adolescent and adult addiction psychiatrist, Director of the Emory Healthcare Addiction Services, and Medical Director of the Addiction Alliance of Georgia. (See the first conversation in this series with MetroHealth.)
Emory Healthcare is an integrated academic medical center in metro Atlanta. As Georgia’s largest healthcare system, Emory is comprised of 11 Hospitals, The Emory Clinic, more than 250 provider locations, 19 regional affiliate hospitals in 17 counties, and over 3,000 physicians. Continue reading to learn how Emory is partnering with renowned organizations to address opioid safety in Atlanta.
At what point did Emory centralize and coordinate opioid-related efforts?
We launched the Addiction Services at Emory Healthcare in 2016. The need for comprehensive opioid-related treatment stemmed from opioid stewardship and changes in expectations across insurance companies, the types of services being provided, and the medical and social landscape of the country.
There was a push through a company called Vizient for organizations to begin tracking what large health systems were doing, such as prescribing naloxone and other opioid prescribing patterns, as well as their readmission rates for overdoses. This has evolved to include multiple layers of automated feedback that we did not previously have access to. Today, we have an opioid dashboard where we monitor prescribing across specialties, identify potential outliers for prescribing practices, and notify supervisors to help mitigate any issues. There is also more individualized access to that data with our conversion to Epic, enabling providers to look at their own prescribing patterns and receive messages from PDMP with their opioid-type dashboards.
LEt’s talk about the Addiction Alliance of Georgia. Can you share the inception story of the Addiction Alliance of Georgia?
Our overarching mission is to prevent and treat addiction, as well as support recovery through evidence-based clinical care, research, and education in the community. We began because of the growing need for a more comprehensive approach across our state. In 2018, we had several community members, volunteers, and business leaders come together to help Emory and the Hazelden Betty Ford Foundation, the nation’s largest nonprofit addiction treatment provider, form what is now known as the Addiction Alliance of Georgia. We are unique because not only do we treat addiction, but we also address any co-occurring psychiatric disorders that a patient may present with such as anxiety, depression, bipolar disorder, or schizophrenia. We also treat across the lifespan, beginning care at the age of 14 and treating patients all the way through geriatrics.
Since 2018, we’ve been able to raise about $11 million in philanthropic support, which has allowed us to build out our center to house expanded clinical programs with multiple levels of care, as well as fund research and education initiatives. After much planning and donor support, we opened our doors at the Emory Addiction Center in October 2022, which is the home base of the Addiction Alliance of Georgia. In the first six months, we’ve seen over 500 unique patients and provided more than 3,000 patient visits. We anticipate that the total number treated will surpass at least 5,000 unique individuals by 2027.
WHat role did Emory play in establishing the Center?
A few influential community partners with close ties to Hazelden Betty Ford wanted to bring something of that scale to the state of Georgia. Emory was then brought into the picture. I was already overseeing the addiction services for Emory, and gained support from our organization to partner with them.
Our clinical services are technically owned by Emory healthcare, which is why it’s the Emory Addiction Center, but Hazelden Betty Ford Foundation manages our intake services and we use their well-established curriculum for our group-based therapies. We share oversight of our research and education programs, which are co-owned. Hazelden’s robust intake services follow the American Society of Addiction Medicine’s (ASAM) patient placement guidelines.
What type of internal and external partners were needed to scale the Addiction Center?
It’s crucial that we align ongoing public and private efforts. We’ve partnered with the Department of Behavioral Health and Developmental Disabilities, or DBHDD, who are the safety net mental health system for the state of Georgia. They have been a partner with us from the inception of the Addiction Alliance of Georgia, making sure that we avoid duplicate services and that we’re filling in the gaps and areas that they’re not already providing. They’ve been one of our funders, especially for our education programs.
We are also now entering into partnership with City of Refuge, which is a housing program for individuals and their children who have suffered domestic violence. With the support of the Chick-fil-A foundation, we’re now going to be providing treatment services to their residents for free.
How much internal education is the Alliance as well as the Addiction Center doing with Emory clinicians?
We have launched an internal addiction training team where we’re targeting Emory healthcare providers whose practices are particularly impacted by addiction and are providing them with the education and tools to meet this challenge and change their practice to better serve these vulnerable patients.
Outside of provider teaching/training, do you provide any community outreach or education?
We do a lot of community naloxone trainings, where we host monthly free trainings at our location and give out free naloxone to anyone who wants to come to that. We’ve also done naloxone training with local school boards. As part of a grant with DBHDD, we’ve formed coalitions with local treatment agencies where we provide the didactic education and content and they allow students to have immersive experiences within their programs. We have a local methadone clinic and a residential program where students get to see and experience what addiction treatment actually looks like. I think it helps to decrease stigma and put a face to the disease of addiction. We’ve been recruiting from a multidisciplinary pool of trainees including students from public health, nursing, medicine, and undergraduate students who might have an interest in understanding what addiction treatment can look like.
What major lessons have been learned since the inception of the Addiction Alliance?
It really boils down to relationships and communication. Collaborations like this can be really complicated on paper. As long as everyone shares that same mission, and you continue to remind yourselves of that mission, then the little details aren’t as important to dispute, and compromise is just more likely. I’d say, consistently asking yourself, why are you doing this? Who are the people that you’re providing the services for, and what is the need? It helps to just re-center. I would also say one of the areas I wish we had paid more attention to from the beginning is the cost of high-quality research. It should be integrated from square one in everything that you do to inform how the programs are developed and in continuously improving processes. When the pandemic hit, I don’t think we were fully prepared to have to adjust to the virtual world, and we still know so little about the role of virtual services and addiction treatment. We really had to shift some of our own resources to catch up on all of these changes and to understand what the new best practices are, which we just didn’t have a benchmark for in the beginning.
What would you share with other health systems who are thinking about going in this direction, but haven’t necessarily had the time or the resources to do so?
I would say the number one barrier is stigma. And if you can just start by combating stigma in your own healthcare organization, things tend to go a long way; patients receive better care, and they’re more likely to ask for help when they need it. Beyond that, there are various approaches to opioid stewardship to decrease the availability of opioids, the number of people who are exposed to them, and screening for potential opioid misuse and delivering earlier interventions.
They should be prepared to manage some of the negative outcomes of opioid use like overdose and ensuring that anyone with an opioid prescription has easy access to naloxone. Then, it’s about actually providing care to individuals who’ve developed an opioid use disorder, and if the organization doesn’t have those resources accessible, forming coalitions or partnerships with agencies that do.
Nearly one in three individuals in their lifetime will develop a substance use disorder. I am constantly surprised how many people have approached me after I’ve delivered a talk who say that their family member is in recovery, or has active addiction. Some of the most adamant advocates are the people who have lost children to overdose, and there’s an entire recovery community out there that is just incredibly strong. Thinking about who you can partner with in recovery, and those local recovery community organizations that can really carry that message forward, is crucial. I think it touches people when you start to talk about it, and it’s not a number on paper, it’s people’s lives.
What’s the vision for the Addiction Alliance of Georgia over the next five years?
It’s all about expanding our resources. One of the areas that I think is missing within our own healthcare system is access to specialized addiction treatment providers in our hospitals. Right now, the Addiction Alliance of Georgia has only outpatient services. But we have plenty of hospitals where people are being admitted for either primary substance use-related causes, or they have a substance use disorder on their problem list. The next step is really expanding services throughout our entire healthcare system and integrating those services into the standard of care for patients, backed with support from Emory and the providers.
Are you interested in discussing opioid safety programs? Are you a clinician on the front lines? If so, what have you witnessed? What are your challenges and successes? Reach out to talk more.
Stay tuned till next week when we will be wrapping our spotlight on opioid safety with a look at enabling technologies, including an interview with the COO and Chief Strategist from Carenostics.
If you missed the first part of this series, check out our conversation with the MetroHealth System’s Office of Opioid Safety and Project Dawn.