Emergency departments become vital entry point to treat opioid-use disorder

On an average month in 2019, emergency departments (EDs) across King County will respond to 217 probable opioid overdoses. That is more than seven a day. In the ED, providers traditionally treat patients with opioid dependence by providing medications to manage the symptoms of withdrawal and often prescribing naloxone to help prevent an overdose in the future.

But now, with local champions leading the way, EDs can address more than acute symptoms and start patients on life-saving medication to treat opioid use disorder and connect them to ongoing treatment in the community. Increasing numbers of physicians are getting the training and certification they need to work with patients to provide buprenorphine, an effective drug to treat opioid-use disorder. Patients taking buprenorphine are more likely to stay in treatment and less likely to die from an overdose. Using medications for the treatment of opioid use disorder can actually reduce mortality risk by 50%.

Over the last year, Public Health convened EDs to look at ways to expand access to treatment. I sat down with one champion leading the change at Valley Medical Center, Dr. Andy Homer, to learn how one emergency department took on the challenge:

Why are Emergency Departments important access points for medication-assisted treatment?
We know that no one wants to end up in the emergency department struggling with opioids. And yet, as ED physicians, we also know that it can be a time when people may be willing to receive help. Ideally that would happen before someone is in the ED, but if not, we realized that we can be a resource and meet people where they are, in a particularly challenging time.

Is there a shift in the culture in emergency medicine that makes providing access to medications like buprenorphine the standard practice?
Emergency medicine providers are less accustomed to starting people on long-term care, often limited by seeing people one time without ongoing follow-up. And yet, treating patients with opioid use disorder should be just like treating someone with diabetes or high-blood pressure. For those conditions, we provide short-term treatment, medication and connect people to care. It’s the same for opioid use disorder. We need to reduce the stigma for these patients.

What were some of the barriers for emergency departments to prescribe buprenorphine?
Providers need to complete an eight-hour training and certification. While I thought this might be a barrier, it turned out that many providers were committed to doing the best for patients. The hospital leadership has been very supportive of the time needed for providers to become certified.

There are also important considerations to be sure patients are linked to outpatient providers who can provide longer term care. We also know that a patient needs to be in active withdrawal to start buprenorphine, so we needed to be able to send someone home with a prescription that they could start at home if needed.

Did anything surprise you about how this change was received?
Overall, I was surprised by how willing providers have been to start conversations with patients about medication-assisted treatment. I also noticed that across the hospital, nurses and staff are starting to talk about how opioids have touched their lives through family and friends. So not only is this an effort to reduce stigma for patients, but also for staff within our own institution.

What would you say to other hospitals considering becoming an access point?
I think this should become standard practice. While we aren’t seeing huge volumes of patients start on buprenorphine, it’s an important start.

I also recognize that we need to do the important work of expanding ties with providers in the community to help link patients to outpatient care easily and quickly.  And, as emergency medicine physicians, we need to continue to learn from one another and continue to adapt to the needs of our patients.