Ambulatory Detoxification

Project 3.a.iv. Development of Withdrawal Management (e.g. ambulatory detoxification, ancillary withdrawal services) capabilities and appropriate enhanced abstinence services within community-based addiction treatment programs.

Alliance staff contact: Kristen Scholl | 518.701.2281

Objective: Develop withdrawal management services for substance use disorders (SUD) within community-based addiction treatment programs that provide medical supervision and allow simultaneous or rapid transfer of stabilized patients into the associated SUD services and provide/link with care management services that will assist the stabilizing patient to address the life disruption related to the prior substance use.

Project Description:  The majority of patients seeking inpatient detoxification services do not require the intensive monitoring and medication management available in the inpatient setting. These patients can be monitored in an outpatient program until stability is assured and, then, rapidly integrated into a collocated outpatient SUD program with a PCP integrated team. Additionally, patients will be provided with care management services that will assist the stabilizing patient to organize medical, educational, legal, financial, social, family and childcare services in support of abstinence and improved function within the community. Care management can be provided as part of the SUD program or through a Health Home strongly linked to the SUD program if qualified for Health Home services. Such programs can address alcohol, sedative and opioid dependency as well as provide access to ongoing medication management treatment.

Definition of Engaged Patients: The number of patients who have received outpatient withdrawal management services at participating sites.

Project Requirements:

  • Develop community-based addiction treatment programs that include outpatient SUD sites with PCP integrated teams, and stabilization services including social services.
  • Establish referral relationships between community treatment programs and inpatient detoxification services with development of referral protocols.
  • Include a project medical director, board certified in addiction medicine, with training and privileges for use of buprenorphine and buprenorphine/naltrexone as well as familiarity with other withdrawal management agents.
  • Identify and link to providers approved for outpatient medication management of opioid addiction who agree to provide continued maintenance therapy and collaborate with the treatment program and care manager. These may include practices with collocated behavioral health services, opioid treatment programs or outpatient SUD clinics.
  • Develop community-based withdrawal management (ambulatory detoxification) protocols based upon evidence based best practices and staff training.
  • Develop care management services within the SUD treatment program.
  • Form agreements with the Medicaid Managed Care organizations serving the affected population to provide coverage for the service array under this project.
  • Use EHRs or other technical platforms to track all patients engaged in this project.