Initiating Medication Assisted Therapy in the Emergency Department

Objective: : Drug overdoses from opioids is a significant public health issue that has affected every level of society. Data shows that 90,000 people died of drug overdoses from September 2019 to September 2020, the majority of those being from opioids (CDC, 2021). The Emergency Department has many options to provide patients to assist with harm prevention, get patients to opioid treatment programs, and assist patients during withdrawal using medications.

EBP Model:: We used the John Hopkins EMP model for this project. We reviewed consensus statements from Health and Human Services, the Substance Abuse and Mental Health Services Administration, National Council for Behavioral Health, American Society of Addiction Medicine, American Psychiatric Association, and Centers for Disease Control for best practices related to initiating medication assisted therapy. We also performed a literature search and found qualitative and quantitative research that we could use for implementation in Health Affairs, Annals of Internal Medicine, and The Lancet journals. These provided us with Level 3 and 4 evidence to move forward.

Setting:: Emergency Department in Northern California with 100,000+ visits per year, mixed adult and pediatric population.

Participants:: Initially, ED Nurse leadership, ED Provider Leadership, Case Management, and Pharmacy met to discuss and create the program. We obtained grant funding from CA BRIDGE for a Substance Use Navigator (SUN) who we have now hired full time and her experience was vital to the implementation of the program. The Leadership teams worked on clinical education for nursing and Provider staff while Pharmacy worked on obtaining suboxone and the standing order required in our state. Providers also worked on obtaining the X Waiver to be able to prescribe during hours that weren't available at the local clinic.

Methods: : Research articles and consensus statements is still emerging on this topic but early data shows that patients are more likely to stay off opioids when they attend counseling and have strong family and community support. Our community had the resources to support these patients which made it possible for the ED to start talking to patients about getting them into programs if they showed an interest. We had signage in the ED waiting room and triage rooms to help promote the program and gave the staff education about opioid use disorder to help reduce stigma. Each month we measure suboxone prescriptions, opioid use disorder diagnoses, and number of SUN encounters.

Outcomes:: Our data shows increases in the number of SUN encounters, MAT administered and prescribed, and the number of patients diagnosed with substance use disorder which shows the need in our community. This year we are showing a higher average per month than the previous year.

Implications:: This project was important in being part of the solution of the overdose crisis and help patients in the moment when they wanted information or were ready to get help for their opioid use disorder. Other EDs can implement this easily as some of the Provider prescribing requirements have become easier and there is more funding available from Government agencies.