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Explore This IssueACEP Now: Vol 38 – No 04 – April 2019
Benefits for Patients and Physicians
Programs like these can be transformative for OUD patient interactions with the health care system, but perhaps more important, they may be transformative for clinicians as well. Most emergency physicians who I know like to be given problems that they can solve. While patients with OUD can sometimes be “difficult,” I would argue that much of the stigma and bias surrounding these patients comes from our own frustration with the situation. Programs of this kind provide clinicians with the tools necessary to intervene beyond handing out a phone number.
Too often, physicians are asked to simply work harder or do better. To get physicians to accept and embrace change, we need to create systems that make it easier, rather than harder, to do the right thing. These systems require an emergency department willing to engage and also a recovery center willing to grant access. Partnerships with a local recovery center should be predetermined. Standard protocols for screening, dosing, and referral should be in place so that, in the moment, the ED clinician does not have to create a treatment plan on the fly.
The evidence for MAT is clear. From a harm reduction standpoint, interventions such as Suboxone and Narcan can save lives, even if 100 percent sobriety at 30 days is not achieved. MAT and engagement with treatment give patients a way to interact with the medical system as a partner, rather than an adversary, creating the framework to achieve full recovery.
On a higher level, we need to move past thinking about buprenorphine as “substitution therapy” and instead toward the preferred treatment model for this problem. This is a disease that, by nature, includes relapses, much like smoking and chronic obstructive pulmonary disease and carbohydrates and diabetes, and is associated with an extraordinarily high mortality rate.
This will take you more time than simply handing out a phone number. Physicians are being given new tasks to perform during their shifts. However, most emergency physicians will accept the extra time that it takes to screen, administer medications, and make a referral if they believe in the impact.
We have shown at Mid Coast Hospital that you do not need to be in a large urban center to create these programs. In fact, in the under-resourced rural areas of the country, we need the emergency department to participate even more. In the emergency department, we are particularly well positioned to intervene in a way that will change not only your patients’ perception of the health care institution but also your providers’ engagement with these patients. I hope that you consider starting a program in your emergency department.