Emergency Department

In a novel approach, Emergency Departments doctors at several teaching hospitals treat more than overdose symptoms. They start patients on the road to recovery. The high school student was soon hook on the drug and buying it on the street. Eventually her habit led her to heroin. It was a lot cheaper and I got more of it, they says.

For four years, Wilson careen from hit to hit. But when she tried to get help for her addiction, she was turn away. He was told to quit cold turkey and I tried multiple times, but I just couldn’t, they says. It was excruciating. Wilson, now 21, learn about a program to help people with opioid addiction at the emergency department of a local hospital.

Attending emergency physician

From the moment someone decides they don’t want to use any longer, the race is on to how quickly you can initiate medication treatment and continue that treatment without lapse,” says Andrew Herring, MD, an attending emergency physician and associate director of research at Highland Hospital of the Alameda Health System in Oakland, California, which is affiliate with the University of California, San Francisco.

The hospital’s medication assist treatment protocol gives patients three days worth of medication without having to go to the pharmacy. “By giving the patients access to the medication right then and there in the ER, we made it easier for them to start their road to recovery,” Martin says. To continue treatment, the ED partners with a clinic that offers the medication on a short term basis until patients can be transition to a primary care practice for maintenance.

After the program’s success, Massachusetts pass a law in August 2018 mandating that the state’s 80 hospital EDs make medication assist treatment available for all patients. Other states are exploring the model. When a patient presents in withdrawal or seeks help for addiction at Highland, they are triage to a fast-track, diagnose and treat protocol.

Emergency physicians are ideally suit to this problem focus kind of care,” says Herring, who start the program in 2017. They’re not use to working with appointments. And it’s a really pragmatic approach that is perfect for folks early in addiction treatment who often have a multitude of distracting needs.” Highland’s ED doctors were encourage to seek a DEA waiver and nearly all have.

Patients are refer to follw

After the first dose of buprenorphine in the ED, patients are refer to a follow-up clinic staff by ED faculty to continue treatment. Nonclinical support for patients with substance use disorders comes from “navigators,” who are people task with providing motivation, reassurance, and problem-solving savvy. “They help with everything from transportation to childcare, landlords, and legal issues anything need to help patients stay on track,” Herring says.

Over time the intervention has become formalize and it is now in place in every ED in Baltimore. It starts with screening every ED patient for substance use. Those who screen positive are pair with a peer recovery specialist. Patients with opioid use disorder are then offer treatment with buprenorphine as appropriate.

The DEA waiver is less critical to the ED’s medication-assist treatment program, Weintraub says. An emergency DEA exemption clause allows any doctor nationwide to give patients; so one dose of buprenorphine daily for up to three days. And Baltimore has nearly a dozen drug treatment centers; so that patients can be referr to for next day and long-term buprenorphine treatment.

Whether patients are in the ED as a result of an overdose or withdrawal symptoms; or for a drug-related medical issue like an abscess or infection, Weintraub says; hence this is one of the few places where patients may be contemplating making changes in their lives; where you might have an opportunity to engage a patient. Hopefully this will become universally accepted as a way to treat patients.”