Delaware Public Media

Delaware seeks to take the lead on developing overdose system of care

Jul 13, 2018

Gov. John Carney is poised to sign a bill allowing for creation of a statewide system of care for drug overdose patients.

Delaware Public Media’s Nick Ciolino reports the goal of this system would be to offer the same quality of care to anyone suffering from an overdose no matter where in the state they enter the system.

Keith Pettiford works Friday and Saturday nights in the Emergency Department at St. Francis Hospital in Wilmington.

He’s an Engagement Specialist from Brandywine Counseling just down the road, and has worked in drug counseling for going on two decades.

Pettiford started at St. Francis a couple months ago working during the hospital’s peak rush hours. His job is to help connect overdose patients with treatment for their addiction.

PETTIFORD: “It is less a job today than a responsibility—a humanitarian responsibility.”

When people overdose on opioids first responders or emergency department doctors administer Naloxone to reverse the effects of the overdose and save the patient’s life. Once the patient is stable, Pettiford sits down with them to discuss treatment options going forward.

He tries to make a connection.

PETTIFORD: “The first thing I would do when I engage a client is I try to establish or identify a readiness to change.”

But that can often be difficult.

In the ED, Pettiford approaches a nurse to ask the status of a young couple who were each admitted for an overdose. She tells him they have already left.

NURSE:  “They caused a commotion. They had a fit and left. So, they’ll probably be back.”

If the patient DOES express a willingness to seek treatment, Pettiford consults with the doctors to decide what will work best for the individual. He then references a database to see what’s available.

PETTIFORD:  “So if I encounter an individual tonight who we identify may benefit from a detox initially before he or she moves on to another level of care, we can go on to the database and look at the detox centers in the state, see their availability, bed availability and then plug them in.”

Since his start, Pettiford has been able to get 11 people to enter into long term addiction care after surviving an overdose, and he still stays in touch with each of them to be sure they’re sticking with it.

But his position at St. Francis is a new one.

He was brought on by Dr. Sandra Gibney.

Gibney is the Associate Chairman of Emergency Services at St. Francis. She is also a member of the state’s Behavioral Health Consortium—the group that recommended Delaware implement an overdose system of care.

She says St. Francis is going through a paradigm shift in how it addresses the treatment of people who are suffering from substance abuse disorder.

GIBNEY: “In the past, individuals would come in, they would get acute reversal drugs and they would be treated until medically stable. At which time they would typically be discharged from the hospital.”

But now St. Francis seeks to connect those people with long-term care right away. And Gibney says Keith Pettiford’s position is just the beginning.

She expects the hospital will eventually be able to fund more in-house addiction counselors, as well as psychiatric telemedicine services and even on-site medication-assisted treatment with buprenorphine or methadone.

GIBNEY: “It is my mission to make St. Francis be the leader in how opioid and substance abuse care is done in the emergency room.”

And the goal of the overdose system of care bill is to set the standard statewide at all nine of Delaware’s hospitals, among first responders and potentially at stabilization centers the legislation allows the state to create.

Delaware Public Health Director Dr. Karyl Rattay says once the bill is signed, it will create a committee to iron out the details and set protocol.

RATTAY: “We’re going to, as quickly as possible, get those people named and bring people together to start having the conversations around what is needed in EMS, what do we want to see in our emergency departments, what do people think about the stabilization centers can we make this work.”

Delaware would be first to start a statewide system for overdose care.

Rattay says the state is in a unique position to do so, in part, because of its size. She adds the system could serve as a model for other states to follow.

RATTAY: “I do believe that we will be setting a blueprint for many other states. I mean, all states have a trauma system of care in place. This is a model that all states have embraced for other areas.”

Overdose deaths in Delaware have gone up for the past five years with 345 people dying in 2017.

And first responders administered Naloxone more than 27 hundred times last year to just over 19 hundred patients.

The top two goals outlined in the overview of the overdose system of care bill are to decrease overdose deaths and decrease repeat overdose incidents.