The dual factors of a longstanding opioid crisis and an insurance market increasingly reluctant to pay for inpatient treatment services have led Connecticut-based Silver Hill Hospital to launch an outpatient opioid addiction treatment program. Leaders of the effort are emphasizing the program's focus on family engagement and a full year of recovery support following completion of the intensive outpatient phase of services.
“A number of patients and families are looking for an inpatient detox, but unfortunately that's become harder and harder to get,” says John Douglas, MD, clinical director. In the early days of the program's launch this month, Silver Hill is finding receptive reaction from insurers willing to finance all three phases of the outpatient program, including post-treatment recovery support, Douglas says.
Medication treatments for opioid addiction will be encouraged but not required in the program, under which some patients will receive buprenorphine or injectable naltrexone in detox and some who do not need detox could begin receiving the medications during the four-week IOP. Individuals will live at home or in local hotels during their intensive treatment.
“The risk of overdose if these patients relapse is very high; that's why we recommend that they consider a dose of medication,” says Douglas.
He expects that for most patients the detox phase will last less than a week. In the IOP stage, patients will visit a renovated site on the Silver Hill campus each weekday, with three hours of daily group therapy (focused on cognitive-behavioral strategies and substance use education) and weekly individual therapy and medication management. Family members will be engaged from the detox phase forward.
Douglas thinks many of the young adults who he sees as experiencing “failure to launch” in life will be among the targets of the outpatient program; Silver Hill also operates inpatient services for opioid addiction. The initial two phases of the outpatient program cost $9,100, with insurance and private-pay options (no Medicaid clients will be served in the program).
In continuing care, patients will be assigned an advocate who will have regular telephone contact with them. In addition, patients will have the opportunity to return to Silver Hill with their family members monthly for two-hour group sessions to build on the skills learned in the IOP phase.
Douglas says that for the type of patient who is missing outpatient care appointments and/or showing positive drug screens, Silver Hill likely would recommend more intensive treatment services.