Connecting addicts to treatment through the ER

Dec 05 2018

Connecting addicts to treatment through the ER

Study being conducted at three hospitals in Northeast

Could starting medication-assisted treatment for drug addiction in the emergency department be more effective than referring them to outside resources?


Three hospitals in the Northeast are participating in a study to test that concept. The study, called ED Connect, will start patients who screen positive for substance use disorder on medication assisted treatment (MAT) in the emergency department.


Typically, these patients are treated in the ED for their immediate medical needs and referred to outside resources for treatment.


The study is being conducted at Catholic Medical Center in Manchester, Valley Regional Hospital in Claremont and Bellevue Hospital in New York City.


Emergency departments are gateways

Because many patients with substance use disorder use the emergency department as their primary source of health care, the approach makes sense, says William Goodman, M.D., the chief medical officer at CMC. He says those emergency room visits represent a narrow window of opportunity to help those struggling with addiction.


The study focuses on whether busy emergency rooms can successfully screen patients, begin treatment and refer them to ongoing support.


According to the National Institute on Drug Abuse, the Emergency Department (ED) is a critical venue to initiate opioid use disorder (OUD) interventions. ED patients have a disproportionately high prevalence of substance use disorders, are at an elevated risk of overdose, and many do not access healthcare elsewhere.


Despite this, OUD interventions are rarely initiated in EDs. As a complement to the NIDA’s CTN-0069 research project, this study will evaluate the feasibility, acceptability, and impact of introducing a clinical protocol for OUD screening, buprenorphine (sublingual or extended-release) treatment initiation, and referral to ongoing OUD medication treatment in ED settings with high need, limited resources, and differing staffing structures.


“Medication assisted treatment is an effective way to help people who are ready for recovery. When those patients come into the emergency department, they are often in that position—being ready and motivated to get help,” Goodman says, That time in the ED is a narrow and important window.”


Substance use disorder is common among emergency department patients, and many of those patients use the emergency department as their primary source of health care. Often, however, SUD patients who are treated in the emergency department—whether for an overdose or another medical condition—are neither evaluated nor treated specifically for their underlying substance use disorder.  Instead, they are referred to an outside program for treatment.


“That is where we are at risk of losing the opportunity to treat someone,” says Molly Rossignol, DO, addiction medicine specialist at Addiction Treatment in Florida . “Capturing them in the emergency department is associated with a reduction in the likelihood of future overdose. This study will help us understand how to make the model of treating opioid use disorder in the ED successful for patients and providers.”


Testing ERs ability to screen and refer

The study is not intended to examine the effectiveness of MAT among the patients who are treated in the emergency department. Instead, the study looks at whether busy emergency departments can successfully screen patients, begin treatment, and refer them to ongoing treatment support.


Another effort to use emergency care to connect addicts with the Newport Beach Addiction Treatment  and recovery services is being planned in the city of Baltimore. Next spring the city plans to open a 24/7 facility called a stabilization center, using state and federal grants.


Patients seeking emergency care who are under the influence of drugs or alcohol will be diverted to the center, which will provide short-term medical care and connect patients with behavioral health and social services. It will also provide buprenorphine, a drug that can ease the effects of opioid withdrawal.