Background
A male in his 20s with a history of polysubstance use and marginal housing presented to the emergency department (ED) for the third time in two weeks due to an opioid overdose. The patient had experienced 16 overdoses within the past two months, primarily related to fentanyl use.
During the initial encounter, the substance use navigator engaged the patient in motivational interviewing, which led to a breakthrough in the patient's readiness for change. The patient acknowledged his fortune in surviving multiple overdoses and expressed willingness to explore treatment options.
Key Interventions
1. Medication-Assisted Treatment (MAT): The patient was discharged with a prescription for Suboxone, a form of MAT proven effective for opioid use disorder.
2. Immediate follow-up: An appointment was arranged for the patient to visit a MAT clinic the following day, ensuring continuity of care.
3. Post-discharge support: A post-overdose street team was contacted to meet the patient at bedside and accompany him home, providing crucial support during the vulnerable immediate post-discharge period.
4. Coordinated care: Over three encounters, the navigator collaborated with various street teams to ensure safe transport and connections to appropriate services.
5. Comprehensive care approach: A community program specializing in care for marginally housed individuals was engaged. Their multidisciplinary team, including a psychiatrist, social worker, and navigator, met the patient at bedside in the emergency room.
6. Transition to long-term treatment: The patient was escorted to receive Sublocade (extended-release buprenorphine) and admitted to a county urgent care/residential facility on the same day.
Outcome
Following these interventions, the patient progressed to a 90-day residential program and maintained sobriety from the first day of admission. This case demonstrates the effectiveness of a coordinated, patient-centered approach to treating opioid use disorder, combining medication-assisted treatment with comprehensive support services.
The success of this case highlights the importance of:
1. Immediate intervention and MAT initiation in the ED setting.
2. Seamless coordination between ED, community resources, and treatment facilities.
3. Addressing social determinants of health, such as housing instability.
4. Providing continuous support throughout the treatment journey.
This case study illustrates the potential for positive outcomes when substance use navigators effectively coordinate care for patients with complex needs, bridging the gap between emergency services and long-term recovery support.
