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B-CORE: Opioid Response and Education Program

Brigham Comprehensive Opioid Response and Education (B-CORE) Program Provides Institution-wide Response to Opioid Addiction Crisis

At Brigham and Women’s Hospital (BWH), small projects began emerging in various departments in response to the opioid addiction crisis. Earlier this year, BWH adopted an institution- wide response, known as the Brigham Comprehensive Opioid Response and Education (B-CORE) program.

The B-CORE program is made up of a collaboration of experts, including pain specialists, surgeons, hospitalists, nurses, primary care providers, pharmacists, and electronic health information representatives, all of whom work in two task forces focused on issues around opioid prescribing and opioid addiction.

Throughout the year, B-CORE members have developed hospital-wide guidelines for opioid addiction prevention and management, opioid prescribing and chronic pain management.

Joji Suzuki, MD, Director of the Division of Addiction Psychiatry at BWH is head of B-CORE’s addiction task force. His group’s recommendations have already yielded a standardized approach to prescribing opioids and it is now in place at BWH. “It’s remarkable that an entire hospital system has come up with a coordinated plan like B-CORE,” he said.

Early Initiatives Already in Place

B-CORE has implemented several initiatives since its inception:

  • Naloxone is available to at-risk patients in the Emergency Department at no cost and without a prescription.
  • The Outpatient Pharmacy launched a drug take-back program, providing a secure bin to deposit leftover pills so they can be disposed of safely.
  • Brigham and Women’s hospitalists Elizabeth Harry, MD, and Raj Patel, MD, are implementing a framework developed by the Society of Hospital Medicine called RADEO (Reducing Adverse Drug Events Related to Opioids), which provides guidelines for safer opioid prescribing and symptom management.
  • The BWH Pharmacy is collaborating with the electronic health information team to provide clinicians with a high-level view of their opioid prescribing habits.

Suboxone in Hospital Setting

Dr. Suzuki is expanding his team and has been working to move addiction treatment beyond the clinic and into more general medical settings. “As a hospital, we are one of the pioneers in the country to use suboxone in the hospital setting for medically-sick patients,” he said.

As part of the psychiatric service within the hospital, Dr. Suzuki’s team helps medical and surgical teams assess patients for the appropriateness of starting suboxone in the hospital. After a patient begins treatment, they are connected to ongoing treatment following discharge.

Dr. Suzuki says BWH is also a leader in two addiction treatment programs. The first is a novel clinic for pregnant women who are addicted to opioids. The second is an inpatient setting for endocarditis patients who have contracted an infection due to intravenous drug use.

Suboxone in Primary Care

BWH has been a leader in the use of the team-based Collaborative Care Approach, offering suboxone in primary care settings where a psychiatrist prescribes medication with the help of a pharmacist.

According to Dr. Suzuki, patients accepted this model in overwhelming numbers. “If you refer a patient from a primary care clinic to an addiction program, at least 50 percent do not go,” said Dr. Suzuki. “In the first year of our program, 48 out of 50 patients returned for treatment.”

The primary care model also showed a one-year retention rate of approximately 50 percent, which is comparable to most specialty addiction programs, said Dr. Suzuki. “This statistic is a common indicator of a program’s success, as once a patient leaves we presume they have relapsed.”

BWH also offers a suboxone treatment clinic at Brigham and Women’s Faulkner Hospital, a community teaching hospital of BWH located in the Jamaica Plain section of Boston, which has shown similar success in terms of retention rates.

“Offering this lifesaving treatment where patients are most comfortable dramatically reduces stigma,” he explained,” patients are often ashamed to seek help from addiction specialists or psychiatrists.”

A top priority for Dr. Suzuki and the B-CORE team is to establish a “bridge clinic,” a temporary care clinic for patients who need treatment for a substance use disorder after an overdose or hospitalization, but cannot immediately enroll in a long-term program.