By Leigh Farmer

On a sunny Thursday morning in Richmond, Rahul Gupta, M.D., Director of the White House Office of National Drug Control Policy was sitting in a boardroom on the campus of VCU Health, flanked by his team of policy analysts and the First Lady of Virginia, Suzanne Youngkin.

Across the table sat VCU Health professionals, many of whom spend most of their waking moments addressing the disease of addiction – in the lab, in the emergency department and in rehabilitation settings.

No one minced words.

“We have Americans dying every five minutes, around the clock, to the tune of over 100,000 every year,” said Gupta, who brought his team to VCU Health to see the critical work done every day by this group of healthcare professionals. “[VCU Health is] a very important part of the solution. Your priority is to save lives first. And this is important because only when we save someone from an initial overdose can we help them by giving them the opportunity to get into treatment.”

Youngkin echoed the sentiment. “I continue to be impressed with the head work and the heart work that VCU is doing.”

Before the boardroom meeting, Gupta and the First Lady were escorted through the Emergency Department of VCU Medical Center. It is ground zero for treating opioid addiction in Richmond and the surrounding counties. The VCU Health Virtual Bridge Clinic creates a direct link between the emergency department and treatment programs for patients with opioid use disorder. In the emergency department, providers will start patients on buprenorphine, a medication that can help treat addiction, when medically indicated.

The 61-bed unit sees nearly 200 patients each day. Gupta was particularly impressed with the care that each patient receives.

“(At VCU Health) you meet people where they are but you don’t leave them there,” he said.

It starts with removing the stigma around addiction; treating patients with dignity and respect as they walk through the doors of any VCU Health facility to get the care they need. Thanks to the ongoing research in addiction medicine, and the training of VCU Health staff, there is a deeper understanding of the disease.

A few decades ago, “nonfatal overdose patients would leave 1 to 2 hours later with nothing,” according to Brandon Wills, D.O., addiction medicine specialist, medical toxicologist, previous emergency physician and associate professor in the VCU School of Medicine's Departments of Psychiatry and Emergency Medicine. 

Now, high-risk patients leave with naloxone, a drug that quickly reverses the effects of an overdose, and an appointment for intensive outpatient treatment for addiction. VCU Health is the first in the commonwealth to begin such a program. And providers immediately schedule patients for a follow-up visit with the VCU Health Multidisciplinary Outpatient Intensive Addiction (MOTIVATE) Clinic. For people with severe opioid use disorder, “there really is a short time period to start the engagement process,” Wills says.

Back in the boardroom, the group agreed that the emergency room is only the first step in a patient’s journey to recovery.

“If you are going to go to war, you better bring an army,” said Bob Findling, M.D., chair of the VCU School of Medicine’s Department of Psychiatry. It’s advice he got from his mentor many years ago. “So that’s what we’ve done. We’ve assembled an army.” However, Findling knows there is always room at the table for more recruits. In fact, there is a major shortage in mental health and addiction professionals nationwide.

In the next 15 years, Gupta says there will be a nationwide shortage of 42,000 psychiatrists, 87,000 of addiction counselors, and 69,000 of mental health counselors. As a teaching hospital, VCU Health works hard to train future clinicians. Most go through a psychiatric rotation, something Gupta appreciated. “If there’s any clinician that thinks they don’t have people with substance use disorders, then they don’t know their patients well. And that’s the bottom line.”

Additionally, VCU Health is always looking for incentives for students. For example, those who choose to practice in the MOTIVATE Clinic, have the chance to have their student loans paid off.

“We’re going to expand (incentives like that) to the extent that Congress will allow us – just push for that all the time,” Gupta said.

Gupta’s last stop during his visit to VCU was a town hall with medical professionals and students from VCU School of Medicine.

“Right here at VCU, you are at the epicenter of some of the best research that is happening,” Gupta said.

He sat next to Gerry Moeller, M.D., the associate vice president for clinical research at VCU. As the principal investigator for the university’s Clinical and Translational Science Awards Grant from the National Institutes of Health, Moeller leads the VCU Institute for Drug and Alcohol Studies. The institute conducts groundbreaking research on addiction medication development, community engagement, the neurobiology of addiction, and other studies. The research – done through continued grant funding from various sources, including the National Insitute on Drug Abuse – has laid the groundwork for discoveries across the country and addressed the shortage in professionals.

“We’re able to work with the health system on workforce development,” Moeller said. “The other piece of this that has been really impressive to me since coming here, is across the school of medicine and across the different departments, everybody’s been collaborative. Emergency medicine has been a huge partner in this space.”

The university connected to the health system is home to several other nationally renowned centers and institutes focused on better understanding addictions and developing substance use preventions and treatments including the VCU Alcohol Research Center and the Virginia Institute for Psychiatric and Behavioral Genetics.

At the end of the visit, Gupta’s closing words re-affirmed the work of the clinical staff at VCU Health and the researchers from the medical college and university.

“I think some of those critical breakthroughs will potentially come from here. Whether it’s the peer support workers or the next new [medication], we're really excited and looking forward to those type of things coming out of here,” Gupta said. “We are very excited about the future and where VCU is going.”

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