In 2017, Yale’s Department of Internal Medicine established a Program in Addiction Medicine to further enhance its pioneering research, education, and patient care. Since then, the addiction medicine experts have continued to lead the field with a fellowship program, which was recently accredited by the Accreditation Council for Graduate Medical Education. In another key step, in collaboration with Yale New Haven Hospital, the Program in Addiction Medicine has launched an Addiction Medicine Consult Service and appointed Melissa Weimer as medical director. YaleNews spoke to Weimer about the new service, how it aims to impact the opioid epidemic and other substance-use disorders, and what she wants people to know about this ongoing crisis. The following Q&A has been edited.
What need will the Addiction Medicine Consult Service meet?
For patients admitted to the hospital, we will be able to more comprehensively address their substance-use disorder needs. If we initiate medication or other treatments in the hospital for a patient’s substance-use disorder, we’ll also link those patients to the outpatient setting where they can continue to receive services, with the goal of having a seamless transition. We know for patients with substance-use disorder, that’s really important to avoid an interruption in care.
How will the service work exactly?
The medical provider who admits the patient to the hospital will identify the need related to substance use, and request a consult, which will then deploy our team, including me as the addiction medicine physician, an advanced practice provider, a health promotion advocate, and others. We’ll make a diagnosis, make sure we’re treating the patient appropriately, and then facilitate their medical treatment for the underlying condition, which is substance-use disorder. Medical providers have done a really good job of treating the initial medical condition — say, the patient’s abscess or alcohol withdrawal — but we haven’t always addressed the condition, addiction, that actually led to the patient’s hospitalization. This service will address what we think are the underlying substance-use disorders.
There’s been a lot of literature to suggest that hospitalization for a patient with substance-use disorder is a “reachable moment.” It can be a time when the patient is more motivated because they are facing a complication or illness related to their substance use.
How will the service help address the opioid crisis?
We hope to address it in several ways: first, by helping identify patients who would benefit from treatment. Often providers aren’t clear on how to make the diagnosis of an opioid use disorder. We can better identify the problem and talk to the patients about their various treatment options. If a patient is interested in treatment with medications such as buprenorphine, methadone, or naltrexone, we can initiate that treatment in the hospital — which has not been done historically because hospital providers didn’t have the expertise or training to initiate those medications. Then we can link patients to ongoing care after their hospitalization. We are developing a referral network to make those connections to our community partners so that patients aren’t falling out of care when they leave the hospital.
Access to medications such as methadone, buprenorphine, and naltrexone are key to addressing the opioid crisis. Survivors of opioid overdose have a 5% annual mortality rate. Buprenorphine or methadone cut that rate by 60% and decrease HIV and hepatitis C transmission.
Are there similar programs offered at other academic medical institutions? If so, how is Yale’s consult service different?
There are. I started a program at Oregon Health Science University in 2015. We were one of the first models. There are similar models at Harvard and Boston Medical Center, and others are cropping up all across the United States. Addiction medicine is a relatively new and growing subspecialty, or consultative practice, because a lot of hospitals are recognizing that it’s something they need to start addressing. Addiction is increasingly being recognized as a primary driver for ED visits, hospital readmissions, and hospital length of stay. Because of those three important factors, leading hospitals nationwide are recognizing that although it costs money to start a service, it ultimately will be cost-saving and most importantly lead to better patient care and outcomes.
Our service is multidisciplinary, with a board-certified addiction medicine physician as the primary medical provider, along with an advanced practice provider. We’ll also be a training site for our Yale addiction medicine fellows. That’s where we’re beginning, but this is a work in progress. It will be an iterative process where we’ll start with these core components on our team, which may grow or change over time as we see what needs we have. We’re starting at the Yale New Haven Hospital St. Raphael’s campus as the first step in our program development.
How will you measure the consult service’s effectiveness? Any research planned?
We’ll be interviewing and gathering a lot of information about the patients we see. Then we’ll be tracking hospital readmissions and length of stay. We’ll be looking at those two measures as well as physician or provider wellbeing. Research-wise, we will look at individual disease processes or other projects as we go along.
What in your background prepared you for this role?
I’m board-certified in internal medicine and addiction medicine. I did a two-year general medicine fellowship, where I focused on the intersection of pain and addiction. During that fellowship I focused my research and clinical skills on that topic. After graduating from my fellowship in 2012, I was on faculty at OSHU for five years where I started the consult service and was medical director of the treatment center there. For a year and half I was also the medical director of a substance-use treatment center in Albany, New York. For several years, I have focused my clinical time on the topics of hospitalization related to substance-use disorders, improving access to care for substance-use disorders, and leading programs to deliver care for substance-use disorders.
Besides the consult service, what else do you plan to do in the Addiction Medicine program and at Yale?
We’ve expanded our Addiction Medicine Fellowship Program to having two fellows this year. We’ve also enhanced the educational opportunities for our fellows so that they are getting exposure to the inpatient setting on our consult service. We are expanding our collaborations across departments, so working closely with the emergency department. We plan to work with psychiatry and social work, who also see patients with addiction in the hospital. Our Program in Addiction Medicine is growing at Yale across the Schools of Medicine, Public Health, and Nursing, and we’re expanding into more clinical work, in addition to the focus on education and research. We also hope to build stronger relationships and collaborations with community partners who treat substance-use disorder.
What would you like the public to know about addiction that they don’t know?
I think that the message that they’ve been getting from the media has been largely negative. There’s been a lot of coverage of the opioid epidemic but there hasn’t been a lot of coverage of people who are succeeding in treatment.
My job as an addiction medicine provider is to recognize addiction and treat it and help patients recover. I hear from a lot of people that it’s a hopeless condition but that’s actually far from the truth. Recovery is possible. There are medications that work and are really effective. We need to help people understand that, and also understand that if you’re hospitalized because of a substance-use disorder, it’s an important time for us in the medical field to talk to you and offer a treatment. That’s a new standard of care. If you’re not offered treatment during your hospitalization, that’s a failure of the health system. Health systems and providers are increasingly recognizing this. The more we can normalize it, make it part of medicine, and destigmatize it, that will start to change the conversation.