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December 19, 2018

Many EDs turn away patients with substance use disorder. But not at Mass General.

Daily Briefing

    While EDs traditionally haven't had much to offer patients with substance use disorders, Massachusetts General Hospital has adopted a program to start treatment for opioid use disorder in the ED, Felice Freyer reports for the Boston Globe.

    Upcoming webconference: How to tackle the opioid crisis and drug diversion

    An enlightening encounter

    Three years ago, Alister Martin was in his first year of residency at Massachusetts General Hospital, the largest hospital in the state, when a woman with an opioid use disorder arrived in the ED. "I don't want this life," the woman told Martin.

    When Martin asked the attending physician how to proceed, the attending physician said there was nothing they could do for the patient.

    That left Martin disappointed. "We're in the middle of an opioid crisis, and we're kicking people out of the [ED]," he recalled.

    But, Martin's encounter is not uncommon for ED physicians, Freyer reports. A person with a substance use disorder might seek medical attention at an ED for a number of reasons including withdrawal pains, an overdose, an infection, or to seek treatment that can lead to recovery, Freyer reports.

    However, substance misuse treatment programs are established outside of a hospital setting, and when these patients present at the ED, they're often sent home.

    The Get Waivered campaign

    Dissatisfied with his inability to help the woman, Martin went on to launch the "Get Waivered" campaign to encourage ED physicians to get certified to prescribe buprenorphine and treat patients with opioid use disorder.

    Martin discovered that few physicians participated in Mass General's Bridge Clinic, which allows physicians to prescribe buprenorphine, and many were not certified by the federal government to prescribe buprenorphine. Currently, only 6% of U.S. physicians have the waiver that permits them to prescribe the medication, Freyer writes.

    According to Freyer, most ED physicians don't "consider managing addiction to be part of their job," and as a result don't know much about treating the disorder.

    So Martin targeted the new campaign to address those two issues. The campaign included posters, a signup website, and gold pins for the physicians who completed the training. The team made it easy to sign up for the training, and a donor provided money so doctors could complete the course without giving up free time.

    Bridge Clinic Medical Director Laura Kehoe, a physician who taught the training, geared it toward ED staff and incorporated a speaker who was recovering from opioid use disorder.

    Andrew Liteplo, an ED doctor at Mass General, said, "They brought the patient in and you're like, 'Wow, he is totally put together and it looks like his addiction has been completely curtailed and managed,." He added, "It's made me realize how much of a medical disease it is."

    Mass General's success story 

    Once David Brown, the department chair, and other influential physicians took the course, sign ups among skeptical ED doctors increased. By April 2017, 38 of the 42 ED physicians had buprenorphine waivers and donned the gold pins on their lab coats, Freyer writes.

    Word of the program started to spread, and patients with opioid use disorders started showing up at the hospital's ED to receive a supply of buprenorphine and an appointment at the Bridge Clinic.

    "I was blown away by how helpful they were, how much time they were willing to spend on me individually," Louis said.

    While Mass General has seen success in getting more physicians certified to prescribe buprenorphine, the hospital is still assessing patients' follow-up behavior. The hospital is also evaluating whether physicians are actually putting the waiver to use and prescribing buprenorphine. The number of patients who enter treatment through the Bridge Clinic is under 12 people per month (Freyer, Boston Globe, 12/10).

    Access our new resources on the opioid epidemic

    The opioid epidemic is a complex, multi-dimensional public health problem. Use this list of helpful resources on how hospitals and health systems can play a role to treat opioid addiction and prevent further increase in opioid abuse.

    Access our Opioid Resources Here

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