The opioid epidemic continues to ravage communities across the United States, leaving a trail of devastation in its wake. As policymakers and health care experts seek innovative solutions to address this crisis, Steward’s own William Goodman, MD, MPH, Regional Chief Medical Officer of the North Market Massachusetts, co-authored a recently published three-site implementation science study observing the impact of programs that initiate buprenorphine treatment for Opioid Use Disorder (OUD) in high-need, low-resource emergency departments (EDs). This approach is showing tremendous promise for patients on the path to recovery, and quickly being seen as a best practice in combating the opioid epidemic.
The Opioid Epidemic: A Call to Action
The opioid epidemic has resulted in a staggering number of overdose deaths, shattered families, burdened health care systems, and devastated communities. The incidence of opioid overdose have seen a steady incline in the past decade, but overdose death rates exploded to an all-time high during – and in the months after – the COVID-19 pandemic. “This is the crisis of our time,” cautions Dr. Goodman. “The opioid epidemic was the most pressing public health concern before the COVID-19 pandemic and it has outlived the pandemic.”
While a global response was launched to address the devastating effects of the coronavirus, little progress has been made to implement evidence-based, best-practice methods such as administering ED-initiated buprenorphine treatment to patients in EDs—often the front lines of the opioid epidemic.
Seizing the Moment: Why Intervention Must Begin in the ED
Low-resource communities typically face higher levels of poverty, unemployment, and limited educational opportunities, which can add to a sense of hopelessness and despair. All factors that are known to contribute to increased incidence of substance abuse as a coping mechanism. These communities also often lack adequate health care infrastructure, including access to traditional addiction treatment facilities, and many in these communities do not have health insurance coverage or are underinsured, posing significant challenges to receiving treatment and counselling services.
These barriers to accessing timely and effective intervention result in prolonged substance misuse and an increased risk of overdose. Therefore, it is imperative to reevaluate our approach if we are to effectively treat patients who otherwise may fall victim to circumstance. Since EDs are often on the front lines of the crisis, we must take advantage of this critical point of care to initiate intervention for two life-saving reasons:
- Timely intervention: EDs are often the first and only point of contact for individuals with OUD and present a unique opportunity to engage patients in immediate treatment and support. Administering buprenorphine in the ED setting allows for immediate intervention and can help prevent relapse and overdose.
- Bridging the gap to comprehensive care: Initiating interventions in the ED includes medications for OUD and then connecting patients to outpatient ongoing addiction treatment and support services. Facilitating this transition can be particularly impactful in reducing relapses, improving the probability of continuity of care, and increasing the likelihood of successful long-term recovery.
Duty of C.A.R.E.S.
Even as the evidence shows that life-saving ED-initiated treatment is the best practice, its adoption into standard ED practice remains limited. “The tradition in medicine is for several years to pass before a best practice becomes the standard, much to the detriment of those who need the care the most. We owe it to our patients to be better stewards,” remarks Dr. Goodman. “The goal is to rapidly overcome obstacles to promptly deliver effective treatment.”
Steward recognizes how effective this method is and encourages its facilities across the nation to implement this procedure, and to partner with local community-based outpatient detox/opiate centers in their respective community. The findings of this ED-initiated buprenorphine treatment implementation science study by Dr. Goodman and his colleagues, aligns with Steward’s commitment to C.A.R.E.S. (Compassion, Accountability, Respect, Excellence, and Stewardship), and allows Steward’s facilities across the nation to pursue the most efficient approach to improving outcomes for communities heavily impacted by OUD.
“The key to success for Steward, or any health system, is a well-established, community-based network that can provide the vital follow-up care patients need beyond the initial ED dosage,” advises Dr. Goodman. Collaboration to offer comprehensive care in the best interest of the patient remains a major issue that Steward has been and continues to advocate for. These critical partners span multiple fields, ranging from the EDs to Primary Care Providers to Social Workers to Bridge Clinics to Support Groups and many others in between—truly a village of dedicated providers. “As this study shows, the ED is a key ‘front end’ cog to kickstart this teamwork process and it requires the necessary community-based and hospital-based partners to be truly effective,” reiterates Dr. Goodman.
Conclusion
The implementation of ED-initiated buprenorphine treatment programs in high-need, low-resource emergency departments is a growing best practice in combating the opioid epidemic. By providing immediate intervention and seamless continuity of care, we can improve patient outcomes, save lives, and help communities heal.
Dr. William Goodman is the Chief Medical Officer at Carney Hospital, Holy Family Hospital, and Nashoba Valley Medical Center in Steward’s Massachusetts market. He received his medical degree from Tufts University School of Medicine, Master of Public Health from Harvard T.H. Chan School of Public Health and specializes in pulmonology. Though he is trained in pulmonary health, he has a deep passion for public health.
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