By now, you would literally have to be living under a rock not to be aware of the increasing interest in emergency department–initiated medication-assisted therapy (ED MAT). Programs that initiate buprenorphine while patients are still in the emergency department are popping up all over the country and have been featured in The New York Times and elsewhere, but those are still the exception and not the rule.
Mid Coast Hospital is a 94-bed community hospital in Brunswick, Maine. We have a 20-bed emergency department with a three-bed ED behavioral health observation area and see about 30,000 patients annually. We are not dissimilar to any of you in terms of the impact that behavioral health emergencies, substance use, and opioid use disorder (OUD) have had on our department. At the same time that we have seen an increase in demand for substance use treatment, we seem to have experienced a decrease in community and statewide resources downstream of the emergency department.
The Mid Coast Hospital Program
In 2015, the initial D’Onofrio et al study that described ED MAT was published in JAMA. At the urging of one of our physician assistants, who was frustrated with the current state of affairs, we began to meet with our peers from the addiction resource center across town and created guidelines and protocols for ED MAT at Mid Coast Hospital. Blessed with an ED staff willing to take this on and a recovery center willing to grant quick access in follow-up, we created standard pathways so that expectations were predetermined. We provided a short educational session on buprenorphine for our ED providers. We did not require an X-waiver.