Close Print View Issue

Treatment now

Sadie-Knott-11-1-18-1.jpgAfter he injected the heroin into his veins, like many times before, Bill felt a sudden rush of euphoria, but this time things quickly started to feel very wrong—like he was trapped in a car sinking under the water. There was only a tiny pocket of air at the top of this imagined car that kept getting smaller as the water poured in. He struggled to gasp for breath. The next thing Bill remembered was the sound of sirens. When he came to, he was in the back of the ambulance as it was pulling into the hospital emergency department. Bill had just been given an injection of Narcan that saved him from a deadly overdose. Now he had a decision to make—should he wait to be treated in the emergency department while going through the painful symptoms of withdrawal or should he leave and relieve his pain with another fix?

This story is fictitious. Bill is not a real person, but this scenario is not far-fetched. People suffering from opioid use disorder can struggle with that same question after facing an overdose—should I stay, deal with painful withdrawal and try to get help? Or should I get another fix to keep withdrawal symptoms at bay?  Marc Hoffman, MD, Emergency Department (ED) physician at Northern Light Mercy Hospital said he’s seen scenarios like this.

“I’ve seen patients where their families have brought them to the ED for intervention and they were at their wit’s end asking if we could help them and we had nothing to offer other than empathy, hotline numbers, and placebo drugs like Tylenol or muscle relaxers. It’s a helpless feeling,” he said. 

Working in partnership with the Maine Department of Health and Human Services, Northern Light Mercy Hospital has now developed a new Rapid Access Treatment Program that should make that decision a lot easier for people with opioid use disorder. “Under this program, anyone who meets the clinical criteria for opioid use disorder can begin treatment with Suboxone while they are in the Emergency Department,” explained Melissa Skahan, vice president of Mission Integration for Northern Light Mercy Hospital. “The patient will also be set up with a patient navigator who can immediately make arrangements for them to get a comprehensive assessment and ongoing treatment.”

Sadie Knott is a board-certified psychiatric mental health nurse practitioner at Northern Light Internal Medicine, Portland, and was instrumental in developing this program with Melissa Skahan. She said most people respond positively to what they were trying to do. “Our Emergency Department has been on board with the idea of rapid access as this program allows them to have a treatment option to offer patients who are looking for help in that momentthis isn’t something they have had before,” she said. “Hopefully, once people learn about this program, we will see a shift in more people willing to come to the ED to seek treatment, especially after an overdose.” 

Sadie is part of the next step in this recovery process. Once a patient leaves the ED, they are required to call Northern Light Internal Medicine, Portland, to set up an appointment with Sadie. In some cases, it can happen the very same day they are treated in the ED. Sadie can prescribe Suboxone in addition to providing psychiatric medication management to address underlying mental health diagnoses; patients are also referred to a social worker at the practice in addition to being set up with a primary care physician. 

As part of the program, a recovery coach will also remain engaged with the patient to assist with treatment and set up community supports such as sober housing, recovery-oriented support groups such as Narcotics Anonymous or SMART Recovery, and ongoing coaching.

Workforce Development is a critical component for patients to assume responsibility for medication costs and ongoing treatment and embrace recovery fully. All patients will be afforded the opportunity to work directly with MaineWorks and be provided employment, appropriate clothing, and transportation supported through the Maine Recovery Fund. 

“It’s truly a comprehensive approach that reaches someone at the moment, when they may be most receptive to getting help, and it assists them along each step of the pathway to recovery,” said Melissa.

“I’ve been involved with a couple of cases already,” Dr. Hoffman said, referring to the Rapid Access Treatment Program. “It aligns goals and it’s very powerful.”

Sadie said, “Through this program, we have the ability to offer patients access to comprehensive treatment in realtime; barriers to treatment, such as wait lists are removed. Any time we can get a patient into treatment when they come in asking for help is an opportunity to save a life.”

For more information on available resources click here: