For patients with Substance Use Disorder (SUD) and Behavioral Health diagnoses, anything that makes sticking to a treatment plan easier has a real impact. That’s why TUH-Episcopal Campus’ Outpatient Pharmacy is offering long-acting injectable medications—which can last two weeks to six months, though the hospital typically uses monthly injections—as part of Temple Health's mission to meet the community’s critical need for Behavioral Health and SUD services.
“Behavioral Health patients have a much higher rate of returning to the hospital within 30 days, usually because they stop taking their medications,” explains LJ Rasi, Episcopal’s Director of Behavioral Health. “When they’re in inpatient treatment, they’ll start taking medications and feeling better. But once they’re discharged, they’ll figure that since they feel good, they don’t need the medications anymore. Then things will go south, and they’ll end up hospitalized again. It’s a vicious circle.”
“But long-acting injectables guard against that whole issue,” Rasi continues. “A patient will get them when they’re discharged, which prevents them from saying, ‘I’m feeling better, I’m going to stop taking my meds,’ or even forgetting to take them for a few days. They’ve really been a game-changer for our patients.”
Removing Barriers to Recovery
According to Frank Breckenridge Chumley Jr., MD, Medical Director of the Substance Use Disorder Clinic, long-acting injectables are just as impactful for patients with SUD diagnoses.
“Many of the patients we serve are unhoused or living in shelters, where it’s very difficult to keep their medications secure,” Dr. Chumley says. “If someone loses a month’s worth of oral or sublingual medication a week into treatment, you’re in a tough spot. Insurers typically cover one early refill a year, and after that, you’re on your own. But long-acting injectables make it impossible for your medication to be lost or stolen once it’s already administered.”
“The injectables also play an important role in how patients approach their recovery,” Dr. Chumley continues. “There are a lot of people who say, ‘I want to make sure I’m doing something active to participate in my recovery every day, like taking this pill.’ But there’s a whole other group that says, ‘I want to forget that this was ever a problem in my life. I want to move on and for my life to be as close to what it was like before all this happened.’ Long-acting injectables are really helpful for that latter group, because they take away the daily reminder.”
Ensuring Connections to Care
Offering long-acting injectables at the Outpatient Pharmacy also ensures patients can access their medications after discharge, preventing unnecessary readmissions.
“In the past, many of the patients we discharged from the hospital were having to rely on outpatient community providers for their medications," says Ali Shahbaz, PharmD, Manager of the Episcopal Outpatient Pharmacy. “It could be very difficult to get appointments at those facilities, which meant they would have to wait two or three months to get their necessary meds. Their only other option was to admit themselves back to the hospital, which created a revolving door. But now, patients who have been seen at Episcopal can continue to come to the Pharmacy for long-acting injectables, even if they’re seeking outpatient care elsewhere.”
For Dr. Chumley, who also administers long-acting injectables during appointments in the Substance Use Disorder Clinic, the option to receive the medication in the Outpatient Pharmacy leaves more time for patient care. “Now that Ali and his team are administering injections in the Pharmacy, it makes my interactions—and those of the other providers in the Substance Use Disorder Clinic—much more focused on having a discussion with the patient and figuring out what they need,” he explains.
Access to long-acting injectables also keeps patients with SUD diagnoses connected to care at Episcopal. “Patients can come here every month and receive these injections indefinitely,” Dr. Chumley says. “This is understood as a maintenance medication for a chronic condition.”
One Patient’s Success Story
Behavioral Health patients who are receiving outpatient care at Episcopal can also get long-acting injectables at the Pharmacy—and Aurelia Bizamcer, MD, PhD, MPH, Professor of Psychiatry and Behavioral Science at the Lewis Katz School of Medicine, has already seen positive results.
“We had one patient who was experiencing residual symptoms of mania and paranoia, which made her a little ambivalent about the long-acting injectable,” Dr. Bizamcer says. “She told us that, because of the Pharmacy staff’s pleasant bedside manner, she ended up feeling comfortable taking the medication. Now, she’s feeling much better—and she’s grateful for the Pharmacy’s services.”