Substance use is a national public health issue. It’s a community issue. It affects people in urban areas, rural areas, suburban, men, women, young, old. The healthcare system has consistently failed people with substance use disorder (SUD), not only due to lack of needed resources, but also often contributing to the stigma and viewing substance use as a personal weakness rather than a disease.
Mobile Integrated Health (MIH) and Community Paramedicine (CP) teams are uniquely poised to address this problem. They see people in their homes or non-healthcare environments. MIH teams across the country are addressing the problem, working to develop innovative, compassionate programs that treat the whole person.
We heard from many of these programs at the spring 2024 MIH Summit, hosted by NAMIHP and Atrium Health.
MIH and SUD: Key Lessons Learned
Substance use requires healthcare and community coordination, which is what MIH does best. By nature, MIH teams can save lives with the proper support. A few themes stood out across all programs:
- Rethinking substance use disorder (SUD). Many leaders had to retrain themselves and their colleagues to recognize that SUD is a medical condition. Programs work when you view the patient as an individual and offer them whole-person care.
- Funding. Funding remains a challenge, and most programs expanded with the help of grant money. But to continue these programs at the end of those grants requires advocacy to get recognition for the work being done. Track data and heartfelt stories to support advocacy efforts.
- Community support. Providing people with whole-person care requires a lot of resources. State EMS organizations, SUD treatment centers, local hospitals, public health departments and more all need to have some buy-in.
- Peer-to-peer training. Whether paramedics teach paramedics or doctors teach doctors, those peer-to-peer conversations are critical to adopting new protocols.
A Closer Look
We talked to those on the ground, implementing integrated programs and working directly with patients. These programs span urban areas, rural areas, large and small communities. Here’s just a sample of what they’ve learned.
Oconee County, South Carolina
Parker Bailes, a community paramedic with Prisma Health, shared his experience implementing a buprenorphine protocol in a rural county outside Greenville, S.C. People were offered buprenorphine after an overdose, whether or not they chose to go to the hospital. One reason for offering buprenorphine at this stage was to make transport and reception at the emergency room (ER) easier.
“Buprenorphine provides some relief from withdrawal symptoms and makes the patient easier to handle in the ER,” he said. “We let them know we’re offering them this medication for the sake of helping them feel better. At the hospital, the patient is seen more as a patient, rather than a problem, which is how they’re commonly perceived. We want the patient and staff to have a better experience in the ER.”
Parker said training paramedics and other healthcare clinicians to look beyond the substance use and see the person was an essential first step. Community coordination is also key. Oconee County has limited resources, but peer support specialists at the hospital connect with patients. Addiction medicine specialists in Greenville will meet with patients through telehealth, and medication-assisted treatment (MAT) trucks travel the county. All of these community pieces needed to be in place before the MIH team began the buprenorphine protocol.
It’s still early, but evidence thus far has shown positive results, with many patients following up on care for their addiction.
Frederick County, Maryland
Located outside the major urban centers of Washington DC and Baltimore, Frederick County’s MIH team has a strong connection between public health and the local fire department. The Community Outreach and Support Team (COAST) program responds to substance use with immediate treatment and wraparound services.
The paramedics spend time in the community, offering harm reduction supplies, including xylazine and fentanyl test strips, wound care kits, personal hygiene kits, sexually transmitted infection (STI) testing kits, naloxone and more. They also provide targeted follow-up after overdose or SUD calls.
The program relies on coordination with 11 treatment centers and peer-to-peer counselors in the hospital. A unique aspect of the SUD program is not only the breadth of personal support services it offers, but also its focus on assisting friends and family of the patient.
“Our team serves the person 911 was called for, but we also offer resources to family and bystanders as well,” said Matthew Burgan, one of two paramedics on the team. In the early days of the program, he responded to a 911 call for an overdose at a hotel known for being a common place for drug users. The patient was transported to the hospital, but down the hall, the individual who called 911 was another individual the peer recovery team had been trying to reach. The peer specialists were able to get that person into recovery.
The COAST program is a 50/50 collaboration between the Fire Department and Public Health Department. The funding had been in place for a while, with solid buy-in for community paramedics from the health department. Grant funding is providing opportunities to expand the program with more resources, more paramedics and longer hours of operation.
Missouri
Urban and rural counties servicing diverse populations in Missouri came together to provide MIH response to SUD. The programs looked different depending on the makeup of the county, but they all took a collaborative approach involving paramedics, local agencies and federally qualified health centers.
Justin Duncan, CEO of the Washington County Ambulance District and a founding partner of the Washington County MIH Network, said breaking down silos is essential. As President of the Missouri EMS Association, he was able to build rapport with decisionmakers at the state and federal level. He also ensured the state’s scope of practice for community paramedics allowed them to practice at the top of their license.
“MIH/CP work is a little bit of patient care and a lot of care coordination,” he said. For SUD response, the paramedics provide comfort care, connect to dentists and other healthcare providers, connect to social workers through telehealth, and work to get people into treatment programs. Justin credits this to relationships the team has built.
“In rural Washington County, we have a crisis stabilization unit about an hour and a half away,” he said. “For patients who are ready, we have had 100% success with getting people in. We’ve navigated every barrier, every roadblock, medical clearance, and often been able to avoid the ER.”
The MIH program in his county and beyond succeed through the collaboration of public health, hospitals, primary care, community partnerships, and law enforcement. Community health workers build on the medical care provided by community paramedics to connect patients with resources to address social determinants of health.
Missouri’s SUD response varied for rural counties, with no hospitals or urgent care centers in the 1,000-square-mile service area, to the wealthiest suburbs of St. Louis. But the MIH teams take a structural approach and collaborate to collect data and share results.
These teams have developed multi-faceted programs that go far beyond the highlights here. And these are just a few examples of the amazing work being done by MIH teams across the country to address substance use.
In a time where resources are few and lives lost are many, MIH is providing the hands-on solutions that communities need.
At NAMIHP, we would love to hear your stories. Feel free to reach out to us at office@namihp.org.