For patients dealing with substance use disorder (SUD) and behavioral health issues, following a treatment plan can be challenging. To address this, the Outpatient Pharmacy at Temple University Hospital–Episcopal Campus has started offering long-acting injectable medications as part of its efforts to support community needs in behavioral health and SUD services.
LJ Rasi, Director of Behavioral Health at Episcopal, highlighted the challenges patients face after leaving inpatient care. “Behavioral Health patients have a much higher rate of returning to the hospital within 30 days, usually because they stop taking their medications,” Rasi said. “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.”
Rasi added that long-acting injectables help break this cycle by ensuring medication remains effective after discharge. “But long-acting injectables guard against that whole issue,” Rasi continued. “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.”
Frank Breckenridge Chumley Jr., MD, Medical Director of the Substance Use Disorder Clinic, pointed out how these medications benefit SUD patients who may struggle with keeping oral medication secure due to unstable housing situations. “Many of the patients we serve are unhoused or living in shelters, where it’s very difficult to keep their medications secure,” Dr. Chumley said. “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.”
Dr. Chumley also noted differences in how people approach recovery: some prefer daily reminders through pills while others want to move on without daily reminders of their condition. He explained that long-acting injectables support those wanting less frequent reminders: “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.”
Ali Shahbaz, PharmD and Manager of the Episcopal Outpatient Pharmacy described past difficulties accessing medication post-discharge: “In the past, many of the patients we discharged from the hospital were having to rely on outpatient community providers for their medications,” Shahbaz said. “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.” Now patients can continue receiving injections at Episcopal’s pharmacy regardless of where else they’re seeking outpatient care.
Dr. Chumley mentioned another benefit: more time during clinic visits is now available for discussion rather than administering injections because pharmacy staff handle those duties.
The program has already shown positive results among behavioral health outpatients at Episcopal according to Aurelia Bizamcer MD PhD MPH from Lewis Katz School of Medicine: “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 said.“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.”
