May 11—Barry Falzone overdosed on heroin in February 2010. Paramedics administered naloxone to resuscitate him.
He remained in the emergency department at SwedishAmerican Hospital for a couple of hours, enough time for the staff to make sure his blood pressure, pulse rate and other vital signs were normal. He was sent home with instructions telling him where to get treatment outside the hospital. At the time, that was standard procedure for hospitals across the country.
Falzone had trained to be a diesel mechanic but suffered from depression and didn't work much in the field. He died in February 2011 at age 25 after overdosing on heroin again, one of nearly 400,000 people in the U.S. to die from opioid overdoses from 1999 to 2017, according to statistics from the Centers for Disease Control and Prevention.
His mother, Bonnie Falzone-Capriola of Loves Park, can't help but wonder how things might have turned out if her son had received the kind of medical treatment and behavioral support that SwedishAmerican will begin offering by the end of May to those addicted to opioids.
"I have been sick for years because the hospitals were not involved ... doing nothing but pushing them out the door," she said. When her son was discharged from the ER, a nurse wrote in his aftercare report: "STOP USING HEROIN!"
"It was heartbreaking," Falzone-Capriola said of the nurse's comment. "These people should know about addiction. They are the front line."
Nearly a decade later, the opioid epidemic has produced a shift in both attitudes and medical practice. The newest procedure at hospitals here and across Illinois, dubbed the "warm handoff," is designed to provide those who have overdosed and are in the emergency room—or those who are hospitalized for other ailments and want to stop misusing opioids—seamless entry into a recovery program along with a short-term supply of drug treatment medication.
"Hallelujah," Falzone-Capriola said of the new hospital practices. "It's a shame it hasn't happened sooner."
Jamie Harwood, Peoria County coroner, echoed her. "Thank, God," he said. "It's about time."
Dr. Jane Pearson, an emergency physician at SwedishAmerican who is training to prescribe medication to treat opioid addiction, said doctors and nurses are "trained on reducing myths. It's not a failing of morality. ... It is not a willpower thing. ... It's understanding that (addiction) is a disease, a chronic relapsing disease."
Two efforts proved by research to bridge the gap between hospitals and drug treatment programs are being undertaken at several Illinois hospitals, including SwedishAmerican and UnityPoint's Methodist Medical Center and Proctor hospitals in Peoria and UnityPoint's Pekin hospital. The initiatives, which will start soon at UnityPoint, involve:
—Offering Suboxone on the spot to patients and sending them home with up to a three-day supply. Suboxone is the brand name for a medicine that combines buprenorphine, a pain reliever, and naloxone. The naloxone negates the intoxicating effects of buprenorphine in the event the user crushes tablets of the pain reliever to try to get high.
—Assigning a certified peer recovery specialist – often a former addict – immediately in the emergency room or in a medical or surgical ward to help the addicted person get to treatment appointments and to provide other support for up to a year.
Dr. Michael Born, president and CEO of SwedishAmerican, said the way hospitals handled drug overdoses in the emergency department in years past was insufficient.
"We were just telling them, 'Take these medicines for symptoms, and 'good luck.' ... I wish this existed when I was an ER doc," Born said.
It's important for SwedishAmerican to undertake the warm handoff program as it handles nearly 60% of the drug overdose patients Rockford Fire Department transports to local hospitals. SwedishAmerican, one of three hospital systems operating in the city, is centrally located. In 2017, 52 patients were readmitted to SwedishAmerican's emergency room for opioid overdoses anywhere from two to six times.
Last year in Winnebago County, 159 people died of drug overdoses—most from opioids—a 28 percent increase from the previous year: 30% were in their 50s, 64% were male, 72% were white.
In Peoria County last year, 58 people died of drug overdoses, down from 67 in 2017.
Winnebago County's population is about 284,000 people; Peoria County's is 181,000. The counties have a similar demographic makeup in terms of race, education and household income.
Research shows warm handoff programs work.
Patients who start Suboxone while hospitalized show reduced opioid use six months after hospital discharge—and almost half enter outpatient medically assisted treatment programs, according to the National Center for Biotechnology Information, which is affiliated with the National Institutes of Health.
Three UnityPoint Health hospitals and SwedishAmerican are among eight Illinois hospital systems awarded federal grants in February for opioid screenings and the warm handoff programs.
A dozen Illinois hospitals that have been using warm handoff programs since mid-2017 admitted to drug treatment programs 75.3% of the 3,140 patients who tested positive for opioid misuse, said Dani Kirby, director of the division of substance use prevention and recovery for the Illinois Department of Human Services. Some were admitted directly to outpatient treatment using methadone, a drug that has been available for a half century to treat heroin addiction.
Others started on Suboxone. Between November 2017 and October 2018 at Rush University Medical Center in Chicago, 99 patients started on Suboxone during inpatient stays. Those patients were among 31,274 admitted to medical and surgical units during that year who were asked whether they had misused alcohol or drugs in the past year.
"They started right there," said Dr. Niranjan S. Karnik, psychiatry professor at Rush Medical College in Chicago, noting patients who agreed to treatment may have been hospitalized for pneumonia or high blood pressure or a host of other illnesses. Rush hadn't started treating patients in emergency departments for drug overdoses but was screening practically all inpatients for drug misuse.
Rush Medical College was among the first to start a screening program for patients hospitalized for a variety of illnesses. The computer-based screening alerts caseworkers nearly immediately to potential opioid addiction and helps funnel patients into treatment. The college is sharing the screening alert system with other hospitals, Karnick said.
Rosecrance Health Network and Remedies Renewing Lives are among agencies SwedishAmerican refers patients to for drug treatment.
"We are on the leading edge with this," said Dr. Thomas Wright, chief medical officer of Rockford-based Rosecrance, which offers addiction treatment and whose physicians prescribe Suboxone.
Remedies also offers treatment with Suboxone, as well as methadone. Methadone is restricted by federal law and given to patients at Remedies' Rockford office daily, except for Sunday's dose, which is given to patients on Saturday to take home for use on Sunday.
Cheryl Pieper, vice president of clinical services at Remedies, said there are 40 to 50 physicians in the Rockford area who can each offer Suboxone to up to 250 patients. The goal of the warm handoff program is to get a person with an opioid misuse problem into treatment within three days of being treated for the problem in the hospital, and providers tell SwedishAmerican that is doable. She said many patients take Suboxone two or three times a day.
"For the right person, it could be a game-changer," Wright said. "It will not fix everything for everybody, but for someone thinking they want to get help but don't know how to manage withdrawal or can't get to a treatment center, this could be helpful," he said.
Hospitals so far have been reluctant to offer medication-assisted treatment, often considering that the work of drug rehab or psychiatric facilities. Despite a "plethora of reasons" to offer such treatment, there are only a "scant number of programs in the nation's 5,500 hospitals" offering it, according to a 2018 story in The Hospital Leader, a blog of the Society of Hospital Medicine.
Doctors and nurses also need a waiver from the U.S. Drug Enforcement Administration and eight hours of training before they can give patients Suboxone.
"Suboxone in the ER is cutting edge at this point, something ERs typically have not done," said Kirby of the Human Services department, which is funding the screening and warm handoff programs throughout the state with federal money. About $8.2 million in grant money is being given to the eight Illinois hospital systems this year to run the screening and warm handoff programs.
SwedishAmerican trained 20 emergency room doctors and nurses to administer Suboxone as part of a $1.8 million two-year grant for the screening and warm handoff program. About 35 doctors and nurses are being trained to get waivers at UnityPoint hospitals. Its three hospitals are receiving $1.7 million in the two-year grant.
"Any gaps in drug treatment are danger zones," said Democratic U.S. Sen. Dick Durbin. "That is why this is so important."
Private insurance companies will pay for those who have coverage. Medicaid, the federal-state program for low-income individuals, will pay for much of the Suboxone and drug treatment programs.
Dr. Tamara Olt, an obstetrician-gynecologist in Peoria whose 16-year-old son Joshua died of an opioid overdose in 2012, is among doctors who prescribe Suboxone in their own practices. "It can be life-saving," she said.
She said she thinks more physicians would prescribe Suboxone if the requirement to get a waiver from the DEA ended. She said it makes no sense that she can prescribe Oxycontin, which can be addictive and potentially more harmful, but not Suboxone, without the waiver.
Being able to prescribe right away can be a key in recovery for a person who wants to quit using opiates, she said. "I can prescribe Suboxone with no wait, get them in very, very quickly."
Dana Northcott, who wrote the request for the grant for SwedishAmerican, said timing is critical. "You have to be able to get people in that brief window" when they say they are ready to quit using opiates, she said, "because it passes so quickly."
She is deputy director of program and funding development for the Region 1 Planning Council in Rockford, and asked her husband Luke Northcott "for a lot of input" when she wrote the grant request for SwedishAmerican. She sought his ideas on what works and doesn't in recovering from opioid use disorder.
Luke Northcott, 40, who lives with his wife and their two daughters in Belvidere, started using Vicodin to ease pain after he broke his arm when he was 21 years old. He moved on to buying Oxycontin for $40 a pill, stealing to pay for the drug. Then he started using heroin at $5 a hit. He said the euphoria heroin gave him was "like floating on warm clouds; it was fantastic." Until, after a while, it wasn't. "There was an absence of joy," he said.
He had been using heroin for about three years when he went into withdrawal in an ambulance, was rushed to an ER and spent 11 days in a hospital without being treated for his addiction. Had the warm handoff offering been available at the time, "I would have been put on Suboxone and changed my life right then."
Luke Northcott, who owns a tattoo business, has been off opiates since 2008. He took methadone to treat his heroin addiction until 2012. He said he wasn't able to fully escape the feeling of being intoxicated so he switched to taking Suboxone daily at home that year. The medicine is contained on a piece of film he slips under his tongue until it dissolves.
He gets Suboxone from a doctor through once-a-month appointments and prescriptions. Suboxone costs him about $5 a month with insurance coverage.
"Now I am living a good life," Luke Northcott said.
Falzone-Capriola is hoping the warm handoff programs do for others what wasn't available to her son.
"We are finally seeing that there are tools," she said. "Is there a guarantee? No, but it's better than nothing. Anything is a good step, because recovery happens differently" for each person. "And a support system is always good."