RI Releases Nation’s First Statewide Standards for Treating Overdose and Opioid Use in Hospitals and Emergency Settings Naloxone distribution, discharge planning, and opioid-use screenings now required


Leadership from hospitals and emergency departments throughout Rhode Island joined
Governor Raimondo’s Overdose Prevention and Intervention Task Force today to release
a first-in-the-nation set of statewide guidelines to save lives by ensuring
consistent, comprehensive care for opioid-use disorder in emergency and hospital

“Ensuring that people who are living with the disease of addiction get the same
high-quality care at hospitals and emergency departments throughout Rhode Island is
essential to preventing overdoses and saving lives,” said Governor Gina Raimondo.
“My heart breaks for each and every person who has lost a loved one to this
epidemic. We need to come together as families, as communities, and as a state to
give people who are living with addictions the resources and support they need.
Change is possible, healing is possible, and recovery is never out of reach.”

In addition to establishing a common foundation for treating opioid-use disorder and
overdose in Rhode Island hospitals and emergency departments, the standards
establish a three-level system of categorization that defines each hospital and
emergency department’s current capacity to treat opioid-use disorder. All emergency
departments and hospitals in Rhode Island will be required to meet the criteria for
Level 3 facilities. As a facility’s capacity to treat opioid-use disorder develops,
that facility can apply for a higher designation.

Hospitals and emergency departments will be categorized based on initial
self-assessments and follow-up evaluations by the Rhode Island Department of Health
(RIDOH) and the Rhode Island Department of Behavioral Healthcare, Developmental
Disabilities, and Hospitals (BHDDH).

Sample requirements for a Level 3 facility (all Rhode Island emergency departments
and hospitals):
* Dispense naloxone to all patients at risk
* Educate all patients who are prescribed opioids on safe storage and disposal
* Provide comprehensive discharge planning to people who overdose
* Screen all patients for substance-use disorder
* Report all overdoses within 48 hours to RIDOH
* Offer peer recovery support services

Sample requirement for a Level 2 facility:
* Maintain capacity for the evaluation and treatment of opioid-use disorder

Sample requirement for a Level 1 facility:
* Maintain a “Center of Excellence” where patients can receive buprenorphine
treatment for opioid-use disorder

The standards were developed by members of Governor Raimondo’s Overdose Prevention
and Intervention Task Force, which is co-chaired by Rebecca Boss, Acting Director of
BHDDH, and Nicole Alexander-Scott, MD, MPH, Director of Health. The standards were
also developed with input from hospitals and emergency departments throughout the
state. Leadership from several hospitals, including Butler Hospital, the Miriam
Hospital, and Kent Hospital, attended today’s Task Force meeting to show their
support for the standards.

“The hallmarks of quality patient care in any individual healthcare facility are
consistency, continuity, and coordination,” said Gary Bubly, MD, FACEP, Medical
Director of the Miriam Hospital’s Department of Emergency Medicine. “Rhode Island is
applying these principles at a statewide level in a way that will profoundly shift
how opioid-use disorder is treated. These standards are a model that can be
replicated in states across the country that we hope will prevent overdoses and save

“The development of these standards by Governor Raimondo’s Overdose Prevention and
Intervention Task Force will ensure that best practices in the treatment of opioid
use disorder are replicated at Butler and at each hospital throughout Rhode Island,”
said Lawrence Price, MD, President and Chief Operating Officer of Butler Hospital.
“A public health issue as significant as the overdose crisis demands this kind of
careful coordination throughout the state.”

The requirement that all Level 3 hospitals and emergency departments provide
comprehensive discharge planning stems from the 2016 Alexander C. Perry and Brandon
Golder Law. The structure and support included in a discharge plan are intended to
help an individual who has overdosed not do so again. For example, a discharge plan
could include patient education, connection to a peer recovery specialist, contact
with a primary care provider, and contact with the patient’s emergency contact.
Alexander C. Perry (the son of former Senator Rhoda Perry) and Brandon Goldner (the
son of Barbara and Brian Goldner, the CEO of Hasbro) had both visited emergency
departments because of substance-use disorder issues prior to their fatal overdoses.
The bill’s lead sponsors were Senator Josh Miller and Representative David Bennett.

At least 329 Rhode Islanders died of drug overdoses in 2016. Although Rhode Island
has seen a steady decline in the number of overdose deaths caused by prescription
medication, the state has seen sharp increases in overdoses caused by the synthetic
opioid fentanyl. In 2016, approximately 57% of Rhode Island’s overdoses involved
fentanyl, compared to 47% in 2015 and 35% in 2014.

The complete standards, titled Levels of Care for Rhode Island Emergency Departments
and Hospitals for Treating Overdose and Opioid Use Disorder, are available online

People can call 401-942-STOP to receive treatment and recovery support.