Carilion Clinic

Carilion Clinic, the largest medical provider in western Virginia, occupies a pivotal place in the account of how the Roanoke region tried to respond to the opioid crisis. It appears both as a frontline health system, where overdose patients arrived in critical condition, and as a potential bridge from emergency care to continuing treatment. That bridge was urgently needed, but the narrative shows how staffing, available treatment, and delays in implementation could leave patients without a reliable next step.

Regional Medical Institution

Carilion Clinic operated within a medical climate that had changed substantially since the introduction of OxyContin in 1996. Hospitals and accreditation bodies were adopting pain assessment standards that treated pain as a fifth vital sign, while patient-satisfaction measures could influence reimbursement. The book describes this wider institutional context as one that encouraged more liberal pain treatment, even as the consequences of expanded opioid prescribing were poorly understood. It does not identify Carilion as the originator of these standards; rather, the clinic was part of the health-care landscape in which they took effect.

The regional consequences of opioid prescribing and addiction eventually became visible in Carilion’s emergency rooms. By early 2017, overdose calls were rising sharply, and emergency physicians in the region were encountering overdoses every day. On some occasions, several severe opioid-related cases arrived at once. These pressures made the clinic more than a site of acute rescue: they raised the question of whether a hospital encounter could be used to connect a patient with treatment before another overdose occurred.

Emergency Care and the Handoff Problem

Emergency physician Karen Kuehl was studying a model used in Ontario, where overdose patients were referred from emergency departments to outpatient medication-assisted treatment and counseling. She sought to establish a similar, smoother transfer in Roanoke with psychologist Cheri Hartman, a coordinator of the Hope Initiative. Their proposal treated the emergency visit as an opportunity to move a patient into continuing care rather than as an isolated episode of stabilization.

The effort ran into practical barriers. Roanoke had too few clinicians able to provide medication-assisted treatment and too few opioid-detoxification and treatment beds. Financial and bureaucratic constraints added further obstacles. While Kuehl and Hartman pursued a grant to improve the transfer process, hospital social workers referred some revived overdose patients to the Hope Initiative. The intended continuity of care therefore depended on a patchwork of hospital staff, volunteer coordinators, treatment providers, and openings that might or might not be available.

The need for an effective handoff was made stark by the circumstances of some emergency cases. In one hour, three patients with severe opioid-related emergencies arrived at Roanoke Memorial Hospital. One had been found unconscious beside the road; another had injected heroin containing fentanyl twice because he believed the first dose had not worked. After resuscitation, he politely thanked the physician and left, saying he had to go to work. The encounter captured the distance between surviving an overdose in the emergency department and being able—or willing—to enter treatment afterward.

Building Recovery Capacity

Carilion was also among the state’s hospital networks working to free funding for peer recovery specialists. Their planned role was to help patients move into treatment after an overdose and to assist people seeking care for opioid-use disorder and mental illness. The program, however, would not be operational for many months. The account describes a system responding in crisis, with interventions that did not always fit together and no consistent arrangement for coordinating them.

That delay mattered because local treatment capacity remained limited. By the time of a later account, Carilion still had a three-week wait for outpatient medication-assisted treatment. A separate community services board had added treatment for twenty-one patients, conditional on their first engaging in counseling; that service was not the same as Carilion’s outpatient program. These examples show the difference between the existence of treatment in a region and its timely availability to a person leaving emergency care.

A separate research effort pointed toward another possible route. Warren Bickel received a one-million-dollar grant for a pilot at the Virginia Tech Carilion Research Institute to streamline transfers from emergency departments to outpatient care. The proposed protocol would connect overdose patients directly to outpatient buprenorphine, including through a newly approved once-monthly injection. This was a research initiative associated with the institute, not evidence that the treatment pathway had already become routine across Carilion’s clinical services.

Continuing Care and Its Limits

The book also situates Carilion in the longer course of opioid-related care. Data cited for babies born in Roanoke to mothers receiving medication-assisted treatment indicated that about half required neonatal intensive care, usually with methadone administered twice a day, for an average hospital stay of 7.7 days. This evidence describes a substantial local demand for neonatal care associated with maternal treatment; it should not be read as a measure of Carilion’s total caseload or as a claim that every such infant was treated there.

Access to care involved financial as well as clinical constraints. An uninsured patient, Jordan “Joey” Gilbert, applied to a hospital-run clinic, and her father used a prescription-price comparison website to find which local pharmacy offered the best price each week. After her death, Carilion Clinic wrote off more than $10,000 of her bills as charity care. The write-off was a concrete response to unpaid medical costs, but it also underscores how treatment and related expenses could remain difficult to manage for an uninsured patient and family.

Significance

Carilion Clinic’s role in the narrative is defined by both reach and limitation. Its emergency department received patients whose overdoses could be reversed, and its clinicians explored ways to connect those patients with continuing care. The proposed systems—peer recovery support, direct referrals, and research on faster transfers—recognized that stabilization alone could not resolve the conditions bringing patients to the hospital. Yet the three-week outpatient wait, shortages of providers and beds, and months-long delay before peer recovery support became operational reveal how slowly a coordinated response could take shape under pressure. Carilion emerges not as a single solution to the regional crisis, but as a major institution where the consequences of fragmented access became visible and where efforts to make treatment follow emergency care were being developed.