The current US opioid epidemic is one of the most serious public health emergencies in recent history. Opioid- related overdose deaths have quadrupled since 1999 making drug overdose the new leading cause of accidental death in the U.S. One of the greatest challenges in addressing the crisis is connecting individuals with opioid use disorders (OUD) with the medical resources they need. Only 10.8% of the estimated 21.7 million people in the U.S. with a past year substance use disorder received specialized addiction treatment. Currently, the Emergency Department (ED) represents a critical missed opportunity to identify and engage patients with OUD in Medication-Assisted Treatment (MAT). To seize this opportunity, a novel ED intervention for OUD at three hospitals within the University of Vermont Health Network is being implemented in 2019 funded by a clinical expansion grant from SAMHSA. Patients presenting with OUD are given the option to immediately start MAT with Naloxone/Buprenorphine (bup/nal) at the ED then referred to a local provider for further treatment. At one of the hospitals, the referral is made to a specialized addiction bridge clinic which monitors patients until the individual is stabilized and transferred to a long-term MAT provider or referred to a higher level of care. Referrals from the ED at the other two hospitals are made directly to a local physician who has been waivered to prescribe buprenorphine. The purpose of this study is to characterize the outcomes of this novel intervention. The primary outcomes measured will be illicit opioid use and treatment retention at 1 week, 3 months and 6 months after initiation of treatment at the ED. These outcomes will be compared to a literature benchmark on this intervention which observed 73% treatment enrollment and low rates illicit opioid use at 2 months after treatment initiation. Outcomes will also be compared between the hospitals with and without the bridge clinic. It is hypothesized that referrals to a specialized addiction bridge clinic will be associated with improved primary outcomes relative to direct referrals to a local waivered physician. Demographic and behavioral data collected at intake will be used to develop a profile of the patients most likely to benefit from the intervention at follow-up. It is expected that a group of patients sharing a common set of characteristics may derive no benefit from the intervention. The behavioral predictors of patients who will benefit from the intervention will be used to develop an efficient short screen to assist ED medical staff identify and appropriately treat patients presenting with symptoms of OUD.
The Emergency Department is a critical missed opportunity to engage patients with opioid use disorder in Medication-Assisted Treatment (MAT), the most effective current treatment for the disorder. Here, we will examine whether Emergency Department-initiated MAT with Buprenorphine/Naloxone in patients presenting with opioid use disorder at three Vermont hospitals will produce positive outcomes in terms of treatment retention and negative screens for illicit opioid use at 1 week, 3 months and 6 months after treatment initiation.
