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Medication Assisted Treatment in a Community Emergency Dept.

December 10, 2019

Written by Clay Smith

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In this community ED, patients were given immediate buprenorphine and rapid outpatient follow up at a substance abuse treatment facility. This led to high rates of follow up and appeared feasible in this setting.

Why does the matter?
More clinicians are getting DEA certification to be able to prescribe buprenorphine to assist in temporary treatment of patients with opioid dependence as a bridge to outpatient care. The authors state, “Medication-assisted treatment (MAT) decreases relapse frequency, reduces morbidity, decreases the likelihood of overdose.” But is this feasible in a community ED?

Is MAT where it’s at?
This was a small prospective study in a community ED, in partnership with a local substance abuse treatment center that offered immediate buprenorphine MAT to patients with opioid dependence who wanted help. Patients could receive immediate treatment in the ED and rapid referral to the local treatment facility. They actually advertised this on local media. Over a year, they enrolled 62 people. I think if we advertised we were giving away narcotics at my shop, we might have a bit higher response than that – just sayin’. Anyway, 81% made it to their first visit (50/62), 86% (43/50) of those made it 30 days on treatment, and 61% (33/50) made it 90 days on treatment. The majority of patients came as a result of local advertising, and most of them had Medicaid coverage. This small study proves feasibility in a community ED setting.

Treating Opioid Withdrawal With Buprenorphine in a Community Hospital Emergency Department: An Outreach Program. Ann Emerg Med. 2019 Nov 13. pii: S0196-0644(19)31104-7. doi: 10.1016/j.annemergmed.2019.08.420. [Epub ahead of print]

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What are your thoughts?