Mentoring, Education, and Clinical Tools for Addiction: Primary Care – Hospital Integration

In the META:PHI care model, patients presenting to any health care setting (primary care, emergency department, hospital, etc.) with an alcohol- or opioid-related condition receive highly effective, evidence-based treatment, and upon discharge are referred to a Rapid Access Addiction Medicine (RAAM) clinic, which they can attend without a booked appointment or formal referral note. RAAM clinics also accept self-referrals, as well as referrals from withdrawal management, community services, and the criminal justice system. At the RAAM clinic, an addiction physician immediately provides counselling, prescribes appropriate addiction medications (such as buprenorphine, naltrexone, or acamprosate), and connects patients to community treatment programs. Once patients are stabilized, they are referred back to primary care for long-term follow-up; the addiction physician provides ongoing support by being available to family physicians for re-assessments, consultations, and advice about addiction care. The META:PHI project has established seven sustainable RAAM clinics across six Local Health Integration Networks (LHINs) as well as integrated care pathways for addiction in each of these communities. Further, the project has supported the gradual spread of this model throughout Ontario and Canada through informal telephone advice and the sharing of administrative and clinical materials. The model is currently being rolled out in Toronto with the following objectives: (a) develop rapid access addiction medicine (RAAM) clinics at five new healthcare sites where patients can access medication-assisted treatment five days a week (b) establish an integrated addiction care pathway within Toronto between all Toronto Central LHIN emergency departments, hospital units, withdrawal management centres and RAAM clinics, as well as primary care clinics, and community service providers; and (c) provide addiction medicine training and support to care providers in these settings.