Dr. Martin’s patient found a dealer back home in the neighborhood she grew up in and texted the dealer to obtain these drugs. When she showed Dr. Martin the text in the ED, she said, “I’m done. Delete my number, I’m getting help.” And the dealer responded back, “Good luck, I hope all goes well for you.” An hour later, she heard a knock at her door and it was her dealer at her apartment who said, “Look, I know what you texted me, but recovery’s hard. Here’s some pills for the road.” Dr. Martin recounts the story as it was told to him that the dealer gave his patient oxycodone for free. That’s when her husband intervened, and they brought her to Dr. Martin in the ED.

“I’m hearing this thinking I’ve been a doctor for all of six days, but absolutely…of course we’re going to help you. You came here and you asked for help. We’re going to help you. It’s what we do,” said Dr. Martin. “And I remember going and telling my attending, ‘Hey look, we got this woman. She’s asking for treatment. I think it’s the perfect time. This is totally reversible for her. I want to admit her, I want to get her into treatment.’ And the attending said, ‘That’s not what we do here.’” Dr. Martin admits his attending was kind, compassionate, and intelligent who was working in a system that just wasn’t set up to help patients like that. “And as a result, I have no idea what happened to that woman. But basically, that walk back from my attending’s desk to the patient’s room was the longest walk of my life,” said Dr. Martin.

It was during that walk that Dr. Martin made a commitment to himself to try and move the needle and make the ED into a proverbial front door for addiction treatment. In 2017, Get Waivered was established to help patients access recovery treatment in the ED. “Probably many other ER physicians were dealing with the same issue and letting patients down in that way,” said Dr. Martin. “So, Get Waivered was an initiative that we started in 2017 to basically get ER physicians their DEA-X waiver so they can prescribe buprenorphine.”

The X-waiver is a piece of legislation from the H.R. 2634-Drug Addiction Treatment Act of 2000 that aims to help emergency physicians prescribe buprenorphine for patients experiencing opioid withdrawal. Dr. Martin’s Get Waivered initiative increases the number of emergency physicians obtaining this waiver. “When we started there were about 400 ER clinicians who had this waiver. We have helped just over 5,000 clinicians of all specialties get the training they need to get their DEA-X waiver over the course of the last six or seven years now with the majority of those being ER clinicians,” said Dr. Martin. “The goal is to try and get 100 percent of ER physicians, and nurse practitioners, and APPs, etc., to get this waiver. Back in the day, you had to pay $200 for this thing, which is absolutely crazy. We made it free and tried to make the shift from common sense to common practice.” Subsequently, on December 30th, President Biden signed the  omnibus bill which removed the X waiver completely. Dr. Martin was invited to the White House to give remarks marking the occasion.