ChristianaCare Union Hospital: A System Implementing What We Know Works

Published: August 31, 2026
Facility: ChristianaCare Union Hospital
Region: Upper Eastern Shore
Featuring: Dr. Greg Wanner, Emergency Physician, ChristianaCare

Tagged

Upper Eastern Shore
Intoxication and withdrawal management
Medications for Opioid Use Disorder (MOUD)

Inclusion is not an endorsement

The Maryland Department of Health shares this account to highlight practices other facilities may find useful. Appearing in this series is not an endorsement, recommendation, certification, or approval of any hospital, health system, provider, vendor, or program by the Maryland Department of Health or the State of Maryland. Descriptions and figures are provided by the participating facility.

“We treat hypertension, diabetes, all that stuff with medication, and we don’t look at people as replacing the insulin from their pancreas with insulin that they inject as a problem.”

— Dr. Greg Wanner, ChristianaCare

ChristianaCare operates a system-wide, evidence-based model for substance use disorder (SUD) care that spans its Delaware hospitals and its Cecil County campus, Union Hospital. The model rests on two commitments: building standardized clinical protocols, and investing in the clinician education needed to put those protocols into practice consistently.

According to Dr. Greg Wanner, an emergency physician who has helped lead the region’s overdose response, that combined approach is what allowed the system to respond quickly during a recent overdose spike. Medetomidine, a sedative adulterant, had entered the local illicit drug supply alongside fentanyl. Over the course of a few months, ChristianaCare experienced an almost 900-percent increase in opioid use disorder (OUD) withdrawal admissions (from 20-25 per month to over 200). The withdrawal syndrome was severe and unfamiliar. Patients who appeared to have improved still felt unwell, frequently leaving the hospital and returning to drug use, only to return within hours. The surge placed significant strain on staff and resources, contributing to burnout and turnover.

With no established protocol to draw on, clinicians built one through trial and error. This involved comparing notes with colleagues in Philadelphia, consulting a veterinary anesthesiologist familiar with the drug, and drawing on guidance from Maryland's Behavioral Health Administration. The resulting approach treats the withdrawal aggressively and early using intravenous dexmedetomidine (Precedex) alongside high-dose clonidine and tizanidine.

Dr. Wanner noted that the most important protocol change addressed what happens after discharge. Because patients often returned with rebound symptoms, the team worked to communicate a protocol utilizing a two-to-three-week clonidine taper that could be continued by community providers. Education in the community was key as well, as many providers were unaware of the severity of medetomidine withdrawal. The guidelines, developed in collaboration with Delaware Public Health, are now in use at the Cecil campus.

Standardizing Buprenorphine Initiation

That same two-pronged intervention—protocol paired with clinician education—also drove the system's work to standardize buprenorphine initiation and shift how providers approach it. The system implemented a focused education campaign in late 2022, followed by formal treatment guidelines in 2023. During this time, it established clear clinical criteria for emergency department (ED) buprenorphine initiation. These criteria were designed specifically to reduce the risk of precipitated withdrawal. Additionally, the system provided home-use instructions for patients not meeting ED criteria, as well as the option to begin treatment immediately following an overdose reversal.

Equally important was addressing the provider stigma that has long slowed adoption. Dr. Wanner has found that framing OUD as a treatable medical condition rather than a moral failing resonates with clinicians. "We treat hypertension, diabetes, all that stuff with medication," he explained, "and we don't look at people as replacing the insulin from their pancreas with insulin that they inject as a problem." Pairing that framing with the recognition that a withdrawing patient's distress is physiological has measurably shifted how staff approach these encounters.

Building On What Works

For hospitals working to strengthen their own overdose response, Dr. Wanner's primary recommendation is to adopt rather than originate: study programs that have already succeeded, such as California Bridge and Cooper University Hospital in New Jersey, and tailor them to local differences in the drug supply rather than building from scratch. He encourages hospitals to create clinical workgroups and reach genuine consensus on guidelines, to use pharmacy and therapeutics committees to update outdated policies with evidence, and to participate in regional data-sharing efforts that track adulterants as they emerge. Looking ahead, he sees long-acting injectable buprenorphine and even pre-hospital initiation by EMS as the next steps toward care that does not depend on a patient reaching the next appointment.

ChristianaCare's experience suggests that durable overdose response depends less on any single program or individual than on the unglamorous work of reaching clinical consensus and committing it to protocol. As Dr. Wanner put it, getting a group of clinicians "to actually agree to things sometimes is a huge accomplishment in itself."

By the numbers

~900%increase in opioid use disorder withdrawal admissions, from roughly 20–25 per month to more than 200
2023formal system-wide treatment guidelines, following a focused education campaign in late 2022
2–3 weeksclonidine taper communicated to community providers to continue after discharge

Figures reflect what the interviewee reported and are provided by the participating facility.

What other Maryland hospitals can take away

Adopt rather than originate. Study programs that have already succeeded, such as California Bridge and Cooper University Hospital in New Jersey, and tailor them to local differences in the drug supply rather than building from scratch.
Convene clinical workgroups and reach genuine consensus on guidelines, and use pharmacy and therapeutics committees to update outdated policies with evidence.
Participate in regional data-sharing efforts that track adulterants as they emerge.
Reframe opioid use disorder as a treatable medical condition rather than a behavioral failing — a framing that measurably shifted how staff approach these encounters.
Educate community providers, not just hospital staff. Many were unaware that the alpha-2 component of medetomidine withdrawal could be more debilitating than the opioid component.
Looking ahead: Dr. Wanner sees long-acting injectable buprenorphine and even pre-hospital initiation by EMS as the next steps toward care that does not depend on a patient reaching the next appointment.

More impact spotlights

Hope as a Strategy — ChristianaCare Union Hospital, Upper Eastern Shore
Meeting a Life or Death Moment With Care — Meritus Health, Western Maryland
Using the DEA 3-Day Rule to Ensure Treatment Continuity — University of Maryland Medical Center, Central Maryland

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