Medication for Opioid Use Disorder: An Overview

By September 4, 2019 November 14th, 2019 Implementation

In the midst of what is the biggest public health crisis since the AIDS epidemic in the mid-1990s, we also have an enormous treatment gap that is exposed nightly in our state’s emergency rooms.

Consider: A recent federal survey found that Massachusetts had by far the highest rate of opioid-related ER visits at 450 for every 100,000 residents, a number 10 times higher than the lowest rate in Iowa at 45 visits. Maryland was a distant second at 300 visits. And yet, the data show us that about 80 percent of patients with substance use disorder do not get the treatment they need. This status quo is unacceptable.

Fortunately, some emergency departments are quickly adopting innovative strategies to provide better care for this population. The treatment that holds the most promise is medication-assisted therapy (MAT) in which doctors administer buprenorphine in the ER, a partial narcotic that is less addictive and easier to taper off than methadone.

For instance, emergency physicians at Yale New Haven Hospital recently tested how administering Suboxone, a brand of buprenorphine, and then referring patients to outpatient providers to continue the medication therapy would impact the rate of persistence with addiction treatment. The result: After 30 days, 78 percent of patients who were given Suboxone and a brief interview remained in treatment while only 37 percent of patients who merely received a referral to an outpatient drug rehab provider remained in treatment.

The authors leveraged a little-known exemption to a federal law that allows emergency providers to administer Suboxone in the ER to treat withdrawal symptoms for 72 hours while permanent treatment is being arranged. That exemption allows doctors to provide this valuable treatment without going through the unpopular Drug Enforcement Administration waiver process that currently prevents 97 percent of all physicians from being able to prescribe the drug.

Another study from Medstar Union Memorial Hospital found that starting Suboxone before hospital discharge decreases return hospital and ER visits and improves patients’ perception of quality of life.

These studies point to potentially life-changing solutions for these vulnerable patients.

Marlie Bruno Author
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