What hospitals can learn from California EDs treating addiction on demand

Oakland, Calif.-based Highland Hospital is among a small number of U.S. emergency departments that give patients withdrawal medicine, an effort to change a healthcare system that often fails to give on-demand addiction treatment, The New York Times reports.

Seven things to know:

1. Highland Hospital is Oakland-based Alameda Health System's flagship facility, with 236 beds. The hospital offers buprenorphine as immediate treatment to patients experiencing withdrawal. Buprenorphine works by easing withdrawal symptoms and cravings and is one of three medications approved in the U.S. to treat opioid addiction.

2. In giving buprenorphine around the clock to people in crisis who may never seek medical care, Highland, along with other institutions starting opioid addiction treatment in the ER, is ensuring it doesn't lose a rare treatment opportunity.

"With a single ER visit we can provide 24 to 48 hours of withdrawal suppression, as well as suppression of cravings," said Andrew Herring, MD, emergency medicine specialist at Highland leading the buprenorphine program. "It can be this revelatory moment for people — even in the depth of crisis, in the middle of the night. It shows them there's a pathway back to feeling normal."

3. For patients beginning addiction medicine, finding a physician who prescribes buprenorphine and takes insurance can be challenging, and long waits for an initial appointment can lead to relapses and overdoses.

4. A 2015 study from Yale-New Haven (Conn.) Hospital found addicted patients who were given buprenorphine in the emergency room were twice as likely to be in treatment a month later as those patients who received an informational pamphlet with phone numbers.

When Dr. Herring read the Yale study, he persuaded the California Health Care Foundation to give a small grant to Highland and seven other Northern California hospitals in 2017 to test dispensing buprenorphine in their ERs.

5. California is spending about $700,000 more to extend the concept as part of a $78 million effort to create a system that provides more access to addiction medications. In this system, ERs would start people on buprenorphine and refer them to a large-scale addiction treatment clinic to adjust to the medication, and then to a primary care practice for continuous care. Dr. Herring is the principal investigator for the project, called ED Bridge.

6. Highland's ER has offered buprenorphine to over 375 patients since February 2017. Two-thirds of the patients accepted it, along with an initial appointment for treatment at the hospital's addiction clinic. Even if patients are reluctant to begin treatment, those who try buprenorphine in the ER may be more likely to do so later, Dr. Herring said.

7. Gail D'Onofrio, MD, lead author of the Yale study, said she's been receiving calls weekly from ER physicians interested in her hospital's model. Since the study's publication, several dozen EDs, including in Boston, New York, Philadelphia, Maine, New Jersey and New York, are now offering buprenorphine.

More articles on opioids: 
Black patients more likely to have opioids prescriptions discontinued, study finds
Trump urges Senate to pass bill curbing synthetic opioid shipments
Opioid epidemic does not influence unemployment levels, researchers find

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