A typical day for certified drug and alcohol abuse counselor Tommie Trevino begins at 7 a.m. in UC Davis Medical Center’s emergency department (ED) as he reaches out to five to eight patients who have come in suffering from withdrawal, psychosis, overdose or other drug- or alcohol-related conditions.
Trevino seizes the life-and-death moment to motivate and educate those in need of treatment on how they can break the cycle of addiction.
From depression to motivation
“When patients come to the ED for drugs or alcohol, it’s one of the worst times of their lives,” Trevino said. “They’re depressed, afraid and ashamed and say that they just want to die. I’m here to motivate them and provide a treatment plan with options and very clear next steps on where and how to access well-established resources in the community to further guide and support their efforts to change.”
Trevino is an integral part of the emergency department’s approach to treating substance abuse, especially opioid addiction.
Prescription medications and rehab programs
“We’ve started looking at addiction as a disease that is treatable rather than a death sentence or moral failing,” said Moulin, who also is president of the California Chapter of the American College of Emergency Physicians. “We identify opioid addiction in the ED and start patients on buprenorphine, an oral medication that significantly reduces withdrawal symptoms. Once stabilized, we give patients a ‘warm handoff’ to Tommie, a certified drug and alcohol counselor with 15 years’ experience who knows local rehabilitation programs and can customize treatment plans.”
The program, which began as a two-year pilot in August 2015, has placed UC Davis Health as one of the leaders in California and across the nation in addressing the opiate crisis.
“Eighty-six percent of patients treated in our ED for opiate use disorder are engaged in outpatient treatment after discharge,” Moulin said.
Moulin, who hopes more hospitals follow suit, is an advocate for state funding that would enable EDs throughout California to hire substance abuse counselors.
California recorded 2,196 deaths from all opioid-related overdoses in 2017, a 12 percent increase from 2015, while Sacramento had 61 deaths from opioid-related overdoses, a 2 percent increase from 2015, according to the California Opioid Overdose Surveillance Dashboard.
Expanding addiction counseling to treat patients
With such clear benefits of specialized counseling for patients and staff, the UC Davis Medical Center is looking to expand drug and alcohol abuse counseling to support patients admitted to the hospital.
“Alcohol and drug addiction is not really well understood,” Trevino said. “It has a stigma. There is a real need for patience and understanding, and people seeing addiction as a disease rather than someone with a problem.”
Last year, UC Davis’ emergency department offered training required under the Drug Addiction Treatment Act of 2000 that qualified physicians for a waiver to prescribe and dispense buprenorphine.
Trevino also hosted a conference on substance use disorders focused on recovery and reducing the stigma of addiction. Helping patients see past their present moment, which is full of fear and anger at themselves, is especially rewarding, Trevino said.
“I hear from patients who I’ve counseled," Trevino said. "It feels good knowing that I helped them and their lives."