Shifting the Stigma Around Opioid Use Disorder

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Care Compass Network is proud to support Arnot Ogden Medical Center’s pilot project to advance the shift in health care and community culture in the treatment of opioid use disorder as a chronic illness such as diabetes or asthma.

At the conclusion of the pilot project, the team at Arnot Ogden Emergency Residency and CASA-Trinity of Chemung county submitted their final Toxicology and Brief Research report on “Treating Opioid Withdrawal with Buprenorphine in a Community Hospital Emergency Department” to the Annals of Emergency Medicine and were recently published in their latest edition.

Brief Summary

Community hospital emergency departments may be effective portals for immediately delivering medication-assisted treatment (MAT) for patients suffering from opioid withdrawal, a recent study shows.

As the opioid epidemic continues exacting a high societal cost, medication-assisted treatment remains the most effective intervention. The treatments generally involve naltrexone, methadone, or buprenorphine. Naltrexone, because it reduced tolerance, increases the risk of fatal overdose in the case of relapses. Methadone requires a federally approved methadone clinic and carries some risk of overdose. Buprenorphine, though, can be prescribed by any physician or advanced-practice provider who takes additional training for a buprenorphine waiver.

The recent study, conducted over 12 months, tested the effectiveness of delivering buprenorphine treatments at community hospital departments. Sixty-two patients were enrolled, evaluated for buprenorphine criteria, and referred for medication-assisted treatment. Of the 62 patients, 53 met the criteria to receive buprenorphine at emergency departments, while nine did not meet the criteria, either because of a lack of sufficient withdrawal symptoms or too-recent usage of opioids.

The study found that patients who received buprenorphine induction at emergency departments had a higher likelihood of keeping their first medication-assisted treatment follow-up visit compared to those who did not receive buprenorphine induction (46 out of 53 patients who received buprenorphine, or 87%, compared to four of nine patients who did not receive buprenorphine, or 44%).

Furthermore, of the 50 patients who complied with their first follow-up visit (46 who received buprenorphine, plus the 4 who did not), 43 (86%) were still in medication-assisted treatment at 30 days, and 33 (66%) were still engaged in medication-assisted treatment at 90 days.

“Our results suggest that an outreach program designed to offer immediate medication-assisted-treatment access for opioid-use-disorder patients is feasible in community hospital emergency departments,” shares, Frank J. Edwards, MD, FACEP, Arnot Ogden Medical Center. This also results in substantial patient engagement, and does not require additional expenditures by the hospital or Drug Enforcement Administration prescribing privileges for buprenorphine.

As the study notes, “Many individuals with opioid-use disorder would likely choose medication-assisted treatment if it were as readily available as street opioids.” Buprenorphine induction in hospital emergency departments may be a more effective method for encouraging follow-ups than referral alone.

For additional information on the research report that was published by the Annals of Emergency Medicine, please click here.

 
 
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