Dr. Meggie Woods (pronouns they/them) is a hospital champion for the CA Bridge program at Sutter Health, Alta Bates Summit in Oakland, CA. As a program champion, Dr. Woods secured at least one doctor within the hospital, and a Substance Use Navigator (SUN) in the emergency department, to provide access to rapid response, evidence-based treatment for substance use disorders.

Before entering medical school, Dr. Woods experienced the life-changing impact of medication for addiction treatment (MAT) while working with HIV and homeless populations. “There was a guy who slept outside in a tent in Massachusetts in the winter, so he wasn’t doing well. But one day, he came bouncing in and looked great. I asked him, ‘Joe, what’s going on?’ He told me that he was on suboxone (a brand of buprenorphine or “bup” and naloxone). But he had to get it on the street because only one doctor was prescribing it in the entire region.”

The overarching need was becoming clear. Dr. Woods describes the situation in the community as being dire, “Heroin had come in strong because of an Oxy bust in the community, and so it was crazy to me that we had this happening but no way to structurally treat it.” This moment was a turning point that informed Dr. Woods’ focus in medical school.

“Treating people isn’t scary or hard. It’s really important and totally something that hospitalists are able to do.”

Dr. Woods specialized in MAT treatment during residency but realized it wasn’t happening at all hospitals. Most of the staff were never trained to use MAT, and many doctors didn’t have the required x waiver to prescribe it. “We started seeing more and more people coming in on suboxone, but no one knew what to do with it in the hospital,” says Woods. So they took matters into their own hands, “I realized there was further education needed. So I started to do a one-hour training at a wine bar. Meet THEM where they are,” laughing, Dr. Woods notes that was the best place to catch a few hospitalists off the clock. Their strategic outreach effort started to work, and their peers began calling with questions.

By promoting MAT one person at a time while staying focused on the big picture, Dr. Woods notes, “I’m pushing for this system-wide. But there have been lots of barriers.” One major hurdle is getting doctors to be invested in treatments that are highly stigmatized. they note that bup is the only drug that requires special training. “There’s nothing else like it. I could prescribe chemo with no training, but this one drug requires an X Waiver. It’s a huge barrier both mentally and because of the amount of time, the training requires. Doctors don’t have a lot of time, so the 8-hour barrier is considerable, and it’s even more for nurses and PAs.”

But despite the challenges, Dr. Woods insists, “Treating people isn’t scary or hard. It’s really important and totally something that hospitalists are able to do.” Support from senior leadership and having someone to administer grants are instrumental. Dr. Woods’ employer, Sutter Health, is now working to make MAT system-wide, including hospitals and OBGYN, outpatient, etc. Dr. Woods cites other positive factors, “Bup is already on formulary in my hospital, which makes it easier. And the grants manager at Sutter was instrumental in hiring our Substance Use Navigator (or SUN), Julian, who was both familiar with our systems and had worked with vulnerable patients in prevention and patient outreach. He was a great fit.”

Dr. Woods credits teamwork for a successful rollout of the CA Bridge MAT model, “I started with no experience doing this at a hospital. But I’ve been surprised how helpful people are willing to be despite the barriers. Finding workarounds and people helping to get things done has somehow made it all come together and work out.” It’s worth the effort. Dr. Woods summarises the most rewarding part of the job is “talking to patients and offering them hope and a different way forward, with frank and honest discussions. That gives me an opportunity to offer medication that can save their lives.”

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