SOCIAL EM & POPULATION HEALTH COMMITTEE
Outside the ED Walls: How One Ohio ED Responded to the Opioid Crisis by Opening a Clinic Lorado Mhonda, MS4 and Sara Urquhart, MS4 RN MA
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his month, fourth year medical student Lorado Mhonda from Case Western Reserve University School of Medicine spoke with toxicologists Dr. Ryan Marino and Dr. Lauren Porter at University Hospitals (UH) in Cleveland, Ohio, about the Medication Assisted Treatment (MAT) Clinic they have spearheaded.
The historical paradigm has been to provide printed resources and let patients call and figure this all out on their own.”
LM: What is a Medication Assisted Treatment Clinic (MAT Clinic)? Dr. Marino: Our goal is to provide medications for initial treatment of addiction. There’s a lot more that can go into it than just medication but the most important would be buprenorphine. Our specific clinic goals have been to increase access and lower the barriers to access. We have our low threshold model which is on a weekly basis, patients can be seen within seven days. We’re currently using telemedicine for controlled substance prescribing which helps with the barrier of needing to be in person because a lot of people do not live close to the Case Western University Hospitals campus. One important point is that we’re not psychiatrists or specialists in addiction psychiatry and addiction medicine. When people need more intense psychiatric treatment and counseling, we refer them. The MAT Clinic is more for people who are just trying to get stabilized on things like buprenorphine. LM: What was the inspiration behind the idea to start the MAT Clinic? Dr. Porter: When we started our toxicology service here we quickly ran into the issue of realizing that the outpatient providers that were able
to see patients to prescribe suboxone were already really overworked and booking patients really far out, so it was hard for patients to get in to see them. That put patients in a really hard scenario where we would get them started on medications either in the emergency department or any inpatient side and then they wouldn’t have anyone to follow up with in a timely manner. With telemedicine increasing significantly and with UH increasing that, we kind of jumped on that. It’s been able to hopefully decrease some of those barriers to patients. Dr. Marino: The historical paradigm has been to provide printed resources and let patients call and figure this all out on their own. This is a particularly vulnerable patient population so being able to have something where the ED can refer them to us and they can be seen within a week was kind of our big motivation. LM:What steps did you take to start the clinic? Dr. Porter: We talked with the chair of our department, our business administrator, and some of our colleagues that work in the inpatient and outpatient world to see how they navigated their setup. We decided to work with our psychiatry colleagues, who usually managed our referrals. We joined their program and joined the psychiatry division and department under the addiction division of it, and then built our telemedicine structure from there. So it was actually easier than anticipated because we are just using a set up that had already been in the hospital system to begin with and really just kind of piggybacked on their model. The biggest thing that we used was their billing plan. Their billing team joined forces along with the emergency medicine department.
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COMMON SENSE JANUARY/FEBRUARY 20221
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