Emergency Care for the Opioid Epidemic: Hospitals Step Up to Offer Buprenorphine in the ED

Both overdose deaths and opioid-related emergency visits are a critical problem for California’s emergency departments (EDs). However, there has been little guidance on what EDs should do with patients who present with signs and symptoms of opioid addiction — other than just saying no to a prescription request.

CHCF is sponsoring pain management and addiction medicine expert Andrew Herring, MD, from Highland Hospital-Alameda Health system to work with eight hospitals across California in 2017-18. These hospitals are starting programs to provide buprenorphine in the ED with close follow-up arranged in an outpatient setting.

Urban pilot sites

  • Alameda County — Highland Hospital’s emergency department working with Highland Hospital’s pain clinic, in the ED Bridge (ED MAT) program
  • San Francisco County — Zuckerberg San Francisco General Hospital working with San Francisco Health Network’s OBIC (office-based buprenorphine induction clinic)
  • San Francisco County — St. Mary’s Medical Center working with San Francisco Health Network’s OBIC
  • San Francisco County — St. Francis Memorial Hospital working with San Francisco Health Network’s OBIC

Rural pilot sites

  • El Dorado County — Marshall Medical Center working with El Dorado Community Health Center
  • Tuolumne County — Adventist Health Sonora working with Forest Road Health & Wellness Center
  • Humboldt County — St. Joseph Hospital Eureka working with Open Door Community Health Center
  • Rural County — to be announced after launch in late October 2017

This project follows a convening of emergency physicians, addiction specialists, behavioral health providers, and policy experts in the spring of 2016 to examine current models of ED addiction treatment and to discuss what it would take to spread these models in California. The meeting focused mostly on the use of buprenorphine in opioid use disorder and injectable naltrexone for alcoholism, globally referred to here as medication-assisted treatment (MAT).

The gathering was part of the California Improvement Network, a community where together, health care leaders learn better ideas for care delivery.

Meeting participants had a number of ideas about what could be done to move ED-based addiction treatment forward in California.

Key highlights:

  • Create compelling narratives, such as “before and after” stories, to create the case for change
  • Develop and spread protocols and workflows to help EDs adapt models to their own settings
  • Seek state- and national-level policy support
  • Mentor new physicians and staff to help them through their initial cases

A summary of the main points made at this gathering, a two-page outline of key strategies, an infographic, and detailed practice protocols are all available under Document Downloads.

This meeting was one of a two-part series. Remedy for the Rural Opioid Epidemic: Leaders Discuss Medication-Assisted Addiction Treatment in Primary Care is a summary of the companion meeting.

Protocols for MAT in EDs

Also available as a Document Download is a detailed outline of clinical protocols for MAT of opioid addiction in EDs, written by Dr. Herring. This document is intended to serve as a resource for EDs across California.