Warm Hand-Off Initiative
The Warm Hand-Off Initiative in Pennsylvania enables patients to immediately start treatment to replace the previous act of giving the patient an appointment card after discharge from the hospital after surviving an overdose (Mauck, 2018). Previous research indicates that most overdose survivors leaving the hospital without practitioner intervention often overdosed recurrently. The city counties and law enforcement ensure that health professionals use emergency service protocols to successfully transfer overdose survivors using an individualized treatment plan with assessment and clinical placement criteria. Therefore, the Warm-Hand Off initiative is a reliable, viable, and long-term approach that works to reduce the prevalence of overdose incidents.
The Audience
The audience for this information is the primary care providers, city counties, criminal justice populations, Substance Use Disorder (SUD) treatment providers, family members, recovery specialists, social workers, law enforcement leaders, first respondents, state agencies, public health officials, mental health agencies, health personnel, and the healthcare insurance providers. The first responders facilitate the identification of survivors needing emergency health care systems
A Summary of the Policy Issue
House Bill 424 of the General Assembly of Pennsylvania (2019), known as the Warm Hand-Off to Treatment Act, provides a comprehensive initiative that facilitates the transfer of overdose survivors to addiction treatment. Under the Overdose Recovery Task Force, Pennsylvania’s Department of Drug and Alcohol Programs (DDAP) initiated an intervention that directly transfers overdose survivors from the hospital’s emergency department to the drug treatment provider (The General Assembly of Pennsylvania, 2019). The policy ensures that health professionals dealing with survivors understand the intense stigma and shame that a drug addict experiences. Hence, health care providers need to treat overdose survivors with care and respect (Miller et al., 2016). Therefore, the warm hand-off policy saves the patient’s life while ensuring that they receive the support needed to avoid a relapse or even death resulting from subsequent overdose.
Identified Key Stakeholders
The key stakeholders of the Warm Hand-Off policy include the first responders who constitute the emergency medical care providers, the law enforcement officers, the family, the social workers, recovering community members, and firefighters (The General Assembly, 2019). The Warm Hand-Off programs need information from the first responders who report repeated overdosing experienced by survivors who do not successfully transition into recovery support service or treatment (Miller et al., 2016). Hence, the community and health care system suffers strain from admission or death reports from survivors that never fully recovered due to a lack of comprehensive treatment and recovery systems.
The collaboration of efforts from first respondents and primary care providers ensures that patients received urgent care to save their lives after an overdose while reporting the occurrence to the program’s officials (Burton & Martin, 2020). The city counties, state agencies, and law enforcement leaders ensure that the stakeholders follow the regulated procedures on admission and reporting. Substance Use Disorder (SUD) treatment providers, as recovery specialists, work to treat and offer recovery from addiction to avoid repetitive overdose incidence (Technical Assistance Center, 2016). The family members, social workers, public health officials, and mental health agencies work to offer a supportive environment for people with drug addiction to reduce associated stigma levels to ensure persisting recovery.
Suggested Policy Action and Identified Policy Arena
The Warm Hand-Off policy ensures that emergency medical services effective practices that medically stabilize addiction victims (The General Assembly of Pennsylvania, 2019). The state’s involvement ensures that the program establishes warm hand-off and overdose stabilization centers accessible for detoxification, referral, assessment, and direct placement to recovery support services (Barnes & McClughen, 2017). The Warm Hand-Off to Treatment Act ensures the coordination and full continuum of recovery support and treatment to address overdose survivor needs for the long term. The Warm Hand-Off to Treatment policy mandates the DDAP to license detoxification facilities that metabolically assist drug-intoxicated, alcohol-intoxicated, alcohol-dependent, and drug-dependent individuals to reduce the physiological risks (Mirigian et al., 2018). Therefore, the suggested policy action offers a comprehensive technique to reduce the prevalence of overdose events in Pennsylvania.
The Rationale for Proposed Action
The rationale for immediate action of transferring a patient from the emergency room to the drug treatment provider is the high risk of repeat overdose after survival. The call to action came to respond to the reversal of 6,500 opioid overdoses across Pennsylvania by January 2018 (Pennsylvania Department of Drug and Alcohol Programs, 2018). As of 2017, the state recorded 5,460 deaths related to overdose prevailing at the top rank in the United States (The General Assembly of Pennsylvania, 2019). These alarming statistics prompted the need to develop a warm-hand-Off initiative to mitigate these rising cases through immediate response. Research indicates that the overdose survivors, once saved, would routinely return to drug usage, increasing the probability of experiencing another overdose (Houry & Adams, 2019). Therefore, identifying, assessing, screening, treating, and tracking as proposed actions under the Warm-Hand-Off to Treatment Act works to save the lives of overdose survivors.
Cost Considerations
The expenditure needed for the Warm-Hand-Off initiative include the purchase of drug supplements, wages for providers of emergency medical services, harm reduction, intervention, transport, and recovery support services, and peer specialists. The Warm Hand-Off Initiative provides incentives to facilitate operations in the highest priority overdose stabilization centers. The Legislative Reference Bureau offers $25,000 per grant to qualified centers in different counties in Pennsylvania (P.A. HB424, 2019). The initiative uses a prorated basis not to award monetary resources to emergency departments and county drug and alcohol administrators that exceed the appropriate amount. Therefore, the state agencies submit annual reports on the use before qualifying for another influx of cash.
Ethical Considerations
The ethical issues facing the Warm Hand-Off policy include the informed consent, privacy, and confidentiality concerns of patients receiving emergency services to save their lives while also being transferred to treatment. Based on the stigma and shame surrounding drug addiction, most overdose survivors do not consent to health care interventions. When patient experiences an overdose, they are incapable of consenting to recovery options used to rehabilitate their status (Burton & Martin, 2020). The short-term drug treatment program fails to achieve long-term benefits if the health care specialists cannot uncover other comorbidities such as their nutrition and income status. Most of the time, practitioners cannot determine the patient’s willingness to participate in the program as indicated by most that repetitively overdose if they do not receive a warm hand-off. Therefore, the programs aim to achieve patients’ consent by making sure that they gain full treatment and consciousness before being transferred to the treatment facility (Ahmed et al., 2019). When the healthcare professionals have sufficient knowledge of drug addiction and the high probability of relapse, they can use a comprehensive healthcare procedure that ensures that the patient does not continue to use drugs after discharge from recovery and support services.
The other ethical consideration is the interdisciplinary disposition of the patient’s health information lacking privacy and confidentiality. Patients, therefore, need information from the healthcare providers about what information is useful. Practitioners also undergo training that enables them to understand that they can use patient data for treatment purposes only and not share it with persons that are not working on that specific patient (Ahmed et al., 2019; Barnes & McClughen, 2017).
Failure to conform to privacy and confidentiality regulations warrants the practitioner’s heavy penalties.
Identified Legislator and Voting Record in the Voting District
The State Representative, Karen Boback, was a sponsor of the warm-hand-off bill, first introduced in 2018 (P.A. HB2727, 2018). House Bill 2727 was a slight partisan appeal with a republican 5-2 vote, which achieved a 25% with no further progression (P.A. HB2727, 2018). Based on the legislator’s position as the chair of the committee, she would expand the grant to cater to overdose survivors’ socioeconomic disparities. Boback should support an initiative that offers a comprehensive solution to the rising incidences of deaths from an opioid overdose. The demographic that experiences the most overdosing incidences occurs in the homeless community, which is rapidly growing. Most homeless people indulge in drug use to escape the inhumane conditions on the streets. When specialists treat them and release them back into the streets, it only predisposes them to indulge more as a coping mechanism. The bill needs to address homeless dynamics. Besides, the results from use result from the youth’s failure to engage in economically productive activities, hence experiencing idle time they occupy with drugs. The lack of socially constructed supportive frameworks fails to equip the youth with coping mechanisms for typical life struggles.
References
Ahmed, O. M., Mao, J. A., Holt, S. R., Hawk, K., D’Onofrio, G., Martel, S., & Melnick, E. R. (2019). A scalable, automated warm handoff from the emergency department to community sites offering continued medication for opioid use disorder: Lessons learned from the EMBED trial stakeholders. Journal of Substance Abuse Treatment, 102, 47–52.
Barnes, M. C., & McClughen, D. C. (2017). Warm handoffs: The duty of and legal issues surrounding emergency departments in reducing the risk of subsequent drug overdoses. University of Memphis Law Review, 48, 1099–1164.
Burton, W., & Martin, A. (2020). Opioid overdose and addiction treatment: A collaborative model of compassion, patience, and respect. Journal of Nursing Scholarship, 52(4), 344–351.
Houry, D., & Adams, J. (2019). Emergency physicians and the opioid overdose action: A call to aid. Annals of Emergency Medicine, 74(3), 436–438.
Mauck, S. B. (2018). Drug dealer or murderer: Pennsylvania’s approach to drug delivery resulting in death. Pennsylvania State Law Review, 123(3), 813–837.
Miller, T., Lauer, A., Mihok, B., & Haywood, K. (2016). A continuum of care approach: Western Pennsylvania’s response to the opioid epidemic [PDF document].
Mirigian, L. S., Pugliese, M. F., Pringle, J. L., & Gaydos, M. F. (2018). The role of community coordinated efforts in combating the opioid overdose crisis: The Pennsylvania opioid overdose reduction technical assistance center. Commonwealth, 20(2-3). Web.
P.A. HB2727, Pennsylvania House Bill 2727, 2017-2018 Reg. Sess. (Penn. 2017-2018).
P.A. HB424, Pennsylvania House Bill 424, 2019, Reg. Sess. (Penn. 2019).
Pennsylvania Department of Drug and Alcohol Programs. (2018). Department of drug and alcohol programs: Opioid epidemic response [PDF document].
Technical Assistance Center. (2016). [PDF Dcoument].