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Rhode Island Releases Nation's First Statewide Standards for Treating Overdose and Opioid Use in Hospitals and Emergency Settings

Leadership from hospitals and emergency departments throughout Rhode Island joined Governor Raimondo's Overdose Prevention and Intervention Task Force today to release a first-in-the-nation set of statewide guidelines to save lives by ensuring consistent, comprehensive care for opioid-use disorder in emergency and hospital settings.

"Ensuring that people who are living with the disease of addiction get the same high-quality care at hospitals and emergency departments throughout Rhode Island is essential to preventing overdoses and saving lives," said Governor Gina Raimondo. "My heart breaks for each and every person who has lost a loved one to this epidemic. We need to come together as families, as communities, and as a state to give people who are living with addictions the resources and support they need. Change is possible, healing is possible, and recovery is never out of reach."

In addition to establishing a common foundation for treating opioid-use disorder and overdose in Rhode Island hospitals and emergency departments, the standards establish a three-level system of categorization that defines each hospital and emergency department's current capacity to treat opioid-use disorder. All emergency departments and hospitals in Rhode Island will be required to meet the criteria for Level 3 facilities. As a facility's capacity to treat opioid-use disorder develops, that facility can apply for a higher designation.

Hospitals and emergency departments will be categorized based on initial self-assessments and follow-up evaluations by the Rhode Island Department of Health (RIDOH) and the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH).

Sample requirements for a Level 3 facility (all Rhode Island emergency departments and hospitals): Dispense naloxone to all patients at risk Educate all patients who are prescribed opioids on safe storage and disposal Provide comprehensive discharge planning to people who overdose Screen all patients for substance-use disorder Report all overdoses within 48 hours to RIDOH Offer peer recovery support services Sample requirement for a Level 2 facility: Maintain capacity for the evaluation and treatment of opioid-use disorder Sample requirement for a Level 1 facility: Maintain a "Center of Excellence" where patients can receive buprenorphine treatment for opioid-use disorder

The standards were developed by members of Governor Raimondo's Overdose Prevention and Intervention Task Force, which is co-chaired by Rebecca Boss, Acting Director of BHDDH, and Nicole Alexander-Scott, MD, MPH, Director of Health. The standards were also developed with input from hospitals and emergency departments throughout the state. Leadership from several hospitals, including Butler Hospital, the Miriam Hospital, and Kent Hospital, attended today's Task Force meeting to show their support for the standards.

"The hallmarks of quality patient care in any individual healthcare facility are consistency, continuity, and coordination," said Gary Bubly, MD, FACEP, Medical Director of the Miriam Hospital's Department of Emergency Medicine. "Rhode Island is applying these principles at a statewide level in a way that will profoundly shift how opioid-use disorder is treated. These standards are a model that can be replicated in states across the country that we hope will prevent overdoses and save lives."

"The development of these standards by Governor Raimondo's Overdose Prevention and Intervention Task Force will ensure that best practices in the treatment of opioid use disorder are replicated at Butler and at each hospital throughout Rhode Island," said Lawrence Price, MD, President and Chief Operating Officer of Butler Hospital. "A public health issue as significant as the overdose crisis demands this kind of careful coordination throughout the state."

The requirement that all Level 3 hospitals and emergency departments provide comprehensive discharge planning stems from the 2016 Alexander C. Perry and Brandon Golder Law. The structure and support included in a discharge plan are intended to help an individual who has overdosed not do so again. For example, a discharge plan could include patient education, connection to a peer recovery specialist, contact with a primary care provider, and contact with the patient's emergency contact. Alexander C. Perry (the son of former Senator Rhoda Perry) and Brandon Goldner (the son of Barbara and Brian Goldner, the CEO of Hasbro) had both visited emergency departments because of substance-use disorder issues prior to their fatal overdoses. The bill's lead sponsors were Senator Josh Miller and Representative David Bennett.

At least 329 Rhode Islanders died of drug overdoses in 2016. Although Rhode Island has seen a steady decline in the number of overdose deaths caused by prescription medication, the state has seen sharp increases in overdoses caused by the synthetic opioid fentanyl. In 2016, approximately 57% of Rhode Island's overdoses involved fentanyl, compared to 47% in 2015 and 35% in 2014.

The complete standards, titled Levels of Care for Rhode Island Emergency Departments and Hospitals for Treating Overdose and Opioid Use Disorder, are available online.

People can call 401-942-STOP to receive treatment and recovery support.

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