PERSPECTIVE

Addressing Opioid Addiction in the Emergency Department, One Patient at a Time

As the opioid crisis continues to affect our communities and patients, Vituity providers are stepping up with innovative solutions to address this urgent issue. One area where we are making a significant impact is by introducing Medication-Assisted Treatment (MAT) in the emergency department (ED). By starting treatment right in the emergency department, Vituity providers are improving patient outcomes and ensuring that those struggling with opioid use disorder receive ongoing care.

Dylan Carney , MD, MPH

MAT Program Director

Published August 26, 2024

Tackling the Opioid Epidemic

My journey to champion MAT in the emergency department began during my residency when one of my attending physicians introduced me to the concept and encouraged me to obtain my DEA X waiver. This initial exposure led me to pursue a fellowship in healthcare management and administration with Vituity, where I collaborated with passionate healthcare leaders across California and the U.S. who were eager to tackle the opioid epidemic head-on.

Over time, the growing body of evidence supporting the effectiveness, feasibility, and cost savings of initiating MAT in the emergency department which have been matched by increasing grant opportunities to implement programs aimed at combating the opioid epidemic. As a result, we’ve seen providers across Vituity seizing the opportunity to build emergency department-based MAT programs and translate evidence into action.

Understanding Medication-Assisted Treatment (MAT)

MAT involves using medications to help treat substance use disorders by reducing cravings and alleviating withdrawal symptoms. It’s a concept many of us are already familiar with. For instance, prescribing a nicotine patch to a patient is a form of MAT.

For opioid use disorder, there are currently three FDA-approved medications: methadone, naltrexone, and buprenorphine. In outpatient settings, MAT is a well-established approach used by community-based substance abuse programs. Buprenorphine is increasingly being initiated in emergency departments and inpatient settings due to its favorable safety and efficacy profile and its ease of use.

Some people, both within and outside the medical community, have asked why we don’t simply wean patients off opioids entirely through detoxification. Well, data consistently shows that relapse rates with detox alone are extremely high, with studies indicating that most patients relapse within 30 days of discharge. In contrast, medications like buprenorphine help reduce the cravings that often lead to relapse, demonstrating stronger results across various outcomes, including treatment retention, return to daily responsibilities, and ultimately, reduced mortality.v

In response to the escalating opioid epidemic and the compelling data supporting the use of MAT for opioid use disorder, more providers are beginning to initiate treatment in the emergency department. In a 2015 randomized control trial published in JAMA, researchers at Yale University randomized emergency department patients presenting with opioid withdrawal to one of three treatment arms: (1) referral to outpatient treatment, (2) referral and brief counseling intervention, and (3) referral, counseling, and initiation of buprenorphine in the emergency department. The results were impressive: Receiving buprenorphine in the emergency department increased a patient’s likelihood of 30-day retention in treatment to 78%, a near-doubling relative to the group receiving brief counseling and referral alone.

Since then, numerous organizations have developed free open-access clinical pathways and educational materials to guide the use of buprenorphine in emergency department and inpatient settings. The California Bridge Program, for example, has created a straightforward buprenorphine guide and other educational materials that can be easily implemented.

Expanding MAT in Emergency Departments

As Vituity's Director of MAT, my goal is to combat the opioid epidemic by expanding access to MAT for patients with opioid use disorders. We are working toward this goal by helping healthcare leaders implement emergency department-based MAT programs and establish connections with outpatient and telemedicine-based treatment programs for aftercare. Since buprenorphine is still relatively new to many providers, we have developed educational tools, including online modules and in-person workshops, to train our frontline providers. Additionally, in response to the limited access to outpatient treatment in many communities, we have partnered with Bright Heart Health, a telemedicine-based provider, to ensure ongoing care for patients after discharge, regardless of their location.

To date, 14 Vituity practices have been awarded grants to implement MAT programs with dedicated Substance Use Navigators as part of the federally funded California Bridge Program. Moreover, many other emergency departments, both within and outside of California, are expanding access to MAT in the acute-care setting without requiring external funding. Between 2018 and 2019, Vituity saw a fourfold increase in the number of practices reporting a buprenorphine program or actively developing one.

Learn more about how Vituity is leading the evolution of emergency medicine with innovative care solutions.

This article was originally published September 24, 2019, updated for accuracy and format.

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