People ready to begin the journey of treatment for opioid use disorder now have a new place to start: the Emergency Department (ED).
In most hospitals around the nation, patients who arrive after opioid overdose or poisoning are treated for the episode, and then referred to existing local treatment programs in the community for Medication Assisted Treatment (MAT). But in the 24 to 72 hours it can take to get to a treatment center, patients are vulnerable to another overdose, death, or changing their minds about whether they’re ready to start treatment.
Now, patients have help making it from the hospital to ongoing community treatment. Here’s how it works: When a patient who comes to the Emergency Department at the UVM Medical Center or Central Vermont Medical Center shows signs of opioid use disorder – regardless of whether they came in with an overdose or an unrelated medical condition – clinical staff talk with them about their options. If the patient is eligible and feels ready to begin treatment, then physicians, nurses, peer recovery coaches and researchers who are available 24/7 begin the process, get them an appointment at the Addiction Treatment Program “hub,” and send them home with a 72-hour supply of buprenorphine to help make sure they actually get there.
“We know that when patients get onto medication assisted treatment, they stop dying, they can start to get their lives back,” said Daniel Wolfson, MD, associate professor of surgery at UVM’s Larner College of Medicine and an emergency medicine physician.
Since the UVM Medical Center began prescribing buprenorphine as part of a research study, ED staff have reported patients coming in and saying they heard from a friend or relative that they could get started on treatment there. While they may need to wait when the ED is very busy, “we want people to come in and ask for help,” Dr. Wolfson said.
The program came about after the realization that while Vermont has responded to the opioid crisis aggressively – expanding access to care through the “hub and spoke” system, reducing the number of pills prescribed, making overdose reversal drug naloxone widely available, and exploring innovative approaches such as having peer recovery coaches on call to support patients – the number of drug-related fatalities in the state continues to increase. Additionally, only an estimated one-third of Vermonters who suffer from opioid use disorder are currently receiving treatment.
“There’s a short window of time when someone might be in the emergency room, thinking about making a change and getting into treatment,” said Cam Lauf, supervisor of the Emergency Department Recovery Support Program at the Turning Point Center of Chittenden County. “Giving people the option to get started right at that moment is a good step.”
With the help of a $1.5 million grant from the U.S. Health and Human Services’ Substance Abuse and Mental Health Administration (SAMHSA) branch, the hospitals will research the approach and expand it at the UVM Medical Center, Central Vermont Medical Center, and Porter Medical Center.
Because the program is being conducted as a UVM study, patients will be asked if they want to participate in the study, commit to treatment and follow up with researchers.
“We really want to be able to prove that this works,” said Steve Leffler, MD, an emergency physician and UVM Health Network Chief Population Health and Quality Officer and interim president of the UVM Medical Center. “What we hope to see is a lot of people being interviewed at the six-month mark, reporting no opioid use for the previous 90 days. Additionally, we hope to see fewer overdoses, recurrent ED visits and opioid-related deaths.”
Central Vermont Medical Center is currently prescribing MAT to patients in their ED. This grant will help continue that work and support rollout of a similar effort at Porter Medical Center. ‘
The grant was awarded in September 2018, and the $1.5 million is available to be distributed over three years, through September 2021. Evaluation data to assess the impact of the project will be collected by Richard Rawson, PhD, professor of psychiatry in the UVM Center for Behavior and Health.
This story was reported by Annie Mackin, with the UVM Health Network.