Daniel Knecht

As our country continues to struggle with the public health challenges associated with opioid use disorder (OUD), a secondary crisis is occurring that is not drawing much attention: repeat opioid-related overdoses. This issue deserves more focus as 

research shows a prior non-fatal overdose is the best predictor of another

, often drawing patients into a terrible cycle of repeat overdoses.

Today, the problem is growing. Emergency department (ED) visits for opioid overdoses rose 30% in all parts of the United States from July 2016 to September 2017, according to the 

Every day, more than 130 people die after overdosing on opioids; many of these patients had overdosed before. Nearly 60% of the overdose deaths were attributed to illicit opioids like fentanyl and heroin, while 18.5% had both illicit and prescription opioids.

Whether people are living in treatment deserts, unable to find specialized care, unaware of medical options, or restricted from accessing effective forms of treatment, all too often, many people who suffer from OUD find it’s easier to access illicit opioids rather than evidence-based care.

In order to effectively address this public health challenge, we need to think differently about the people who struggle with OUD resulting in an overdose in order to develop innovative approaches to breaking the overdose cycle.

How can healthcare professionals, insurers, and other stakeholders help reduce the risk of overdose and encourage uptake of evidence-based addiction treatment and recovery?

Our experience with an innovative post-overdose clinical intervention program offers insights into how to close one critical gap in care for this patient population.

Creating a lifeline for the people who need it most

ED data provides an early warning system for industry stakeholders to identify opioid overdose trends and develop appropriate responses. After a 2018 review of ED claims data revealed hundreds of members each month were being admitted to the ED for opioid-related overdoses, Aetna, a CVS Health company, launched a pilot initiative called 

The program, which engages with and supports patients who overdose, is offering important insights into the drivers for OUD and overdose. It is demonstrating how personal outreach from a trained and impassioned addiction specialist when a patient is most vulnerable-right after an overdose-can be an effective intervention.

People who overdose have complex needs for treatment and recovery. Yet, ED physicians are primarily and understandably focused on treating the emergency, not on the longitudinal care needs of the patient being discharged. Guardian Angels work to close that gap in care.

Since the program’s start in 2018, clinical case managers have connected with more than 600 Aetna members who have suffered an overdose and their families, providing education and resources about the effectiveness of evidence-based addiction treatment. Members who have been contacted range in age from aged 18 to over 60 years old and live in every part of the country. The program is so groundbreaking because it engages with individuals with support when they need it most.

Education and MAT: A powerful combination

One of the key ways Guardian Angels support members is to provide education on evidence-based therapies, including medication-assisted treatment (MAT), the gold standard for OUD treatment. According to a study in the 

, only a third of overdose victims received any MAT for OUD. Yet, compared to those not receiving MAT, overdose deaths decreased by almost 60% for those receiving methadone and nearly 40% for those receiving buprenorphine over a 12-month follow-up period.

Guardian Angels provide members with information on the effectiveness of MAT as well as harm-reduction strategies such as Naloxone an antidote that reverses an opioid overdose. This kind of education combats the perception that MAT is “replacing one drug for another,” an inaccurate perspective that hinders a patient’s openness and connection with professionals who can help.

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Clinical case managers also help to ease the way on locating, navigating and scheduling effective treatment. The extensive clinical experience Guardian Angels have in addiction care make them effective advocates for members who are in 

 to be evaluated for injectable forms of MAT, a critical component of success for some of our members.

Once the clinical case manager connects with the member, the clinical relationship and ongoing conversations about care can stretch for months. The idea is to continue providing support until the patient reaches “early remission,” which usually takes months.

The program’s successes are as unique as the needs of the members who are being supported. Case in point: Mark, a 57-year-old man from Florida who was prescribed opioids after his involvement in a serious vehicular accident in 2012. Like so many people who struggle with OUD, Mark had a challenging time finding the care he needed and developed a dependency on prescription opioids over the years. When he was abruptly weaned off prescription opioids by his providers, Mark experienced agonizing withdrawal and turned to illicit opioids to mitigate his pain. That decision ended with an inadvertent overdose.

When Guardian Angels reached out to Mark, he indicated that he was overwhelmed and had been searching for months for an in-network, Buprenorphine-certified physician who would accept new patients. The clinical case manager took over this stressful process for Mark, identifying the proper physicians, calling each office until an in-network physician who would accept new patients was found, and then scheduling Mark for the first available appointment. Mark has been compliant with treatment and has abstained from illicit opioids for months. He now refers to the Guardian Angel program as a “godsend.”

With the Guardian Angel program, Aetna has seen tangible results from taking a data-driven, proactive approach with members who have suffered overdoses. Engaging with people who struggle with addiction at critical touchpoints in their journey to recovery is key to preventing repeat overdoses. This unique clinical approach also proves the effectiveness of joining patients where they are in their health care journey to connect them with the care and resources they need to be successful.

The approach we’ve taken with the Guardian Angel program clearly won’t solve the opioid epidemic on its own. But we know from first-hand experience that these initiatives are positively impacting the lives of our members and their families. We believe this program can serve as a roadmap for a more proactive approach in helping people deal with addiction, especially post-overdose. Helping guide people to resources, and educating them on the available options, will save lives.

Clearly, there is an industry-wide opportunity to create a system of care for those suffering from OUD that more closely follows the treatment of patients to prevent relapses. A combination of medical treatment, education and personal contact can help get us to this goal.

Daniel Knecht, MD, is vice president of Health Strategy and Innovation, CVS Health. 

Jeff Balek, LCPC, CADC,is a  Guardian Angel clinical lead. 

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An innovative post-overdose clinical intervention program offers insights into how to close one critical gap in care for this patient population.

Author | Daniel Knecht

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