EMpulse Summer 2019

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UPDATES ON THE OPIOID CRISIS:

The MAT Bridge at Tampa General Hospital By Heather Henderson, MA, CAS MAT Team at Tampa General Hospital

By Brandi Travis, MS MAT Team at Tampa General Hospital

Jason Wilson, MD, MA, FACEP, FAAEM MAT Team at Tampa General Hospital

Jack McGeachy, MD MAT Team at Tampa General Hospital

Andrew Smith, MD MAT Team at Tampa General Hospital

REFERENCES 1. D’Onofrio et al. Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence. JAMA. 2015;313(16):1636-1644. doi:10.1001/ jama.2015.3474 2. McLellan, et al. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000. Oct 4;284(13):1689-95 3. TGH received a legal consult on this requirement. Scan the QR code to read it:

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TGH’s MAT Bridge program has a follow-up rate of 57%. The national average is 20%. The increasing mortality rate from opioid overdose is evidence that the opioid epidemic is still ongoing. In the past, emergency departments had little resources for patients with opioid use disorder (OUD). However, newer medications, increased awareness and public recognition of this public health crisis allow for a new approach to patients seeking care for OUD in the emergency department (ED). Patients with OUD are consistently at an increased risk of adverse health outcomes versus non-OUD patients. Patients with OUD may present to the ED with healthcare issues directly related to OUD, co-morbidities or acute illnesses and trauma1, or with other complaints within the context of concomitant addiction. For emergency medicine, this means extending care structures past the initial clinical encounter in order to achieve greater success with patient outcomes. The acute treatment of OUD has historically fallen outside the scope of practice for ED providers, but this new disease-state legitimacy (as a chronic relapsing disorder) has shifted attitudes, with providers stating that “the detection and initiation of treatment for chronic and relapsing medical conditions (e.g., hypertension, diabetes and asthma) is not an uncommon ED practice.”2 To this end, we have built a medically-assisted treatment (MAT) program at Tampa General Hospital (TGH) that complies with state laws (which do not require a DEA waiver to administer buprenorphine in the ED3), and also shows strong evidence that supports utilization of MAT treatment in an acute setting of patients with OUD. This pathway both follows and also redefines best practices. EMpulse Summer 2019

Through this program, TGH has been afforded a unique opportunity to forge an exciting community partnership with DACCO, the largest provider of MAT, rehabilitation, outpatient care and wrap-around services for patients suffering from substance use disorder in Hillsborough County. Patients referred to DACCO from the TGH ED in need of MAT services will, in most instances, be able to initiate treatment same-day, with no patient going more than 72 hours without initiation of treatment. What we believe sets this program apart from traditional referrals is the actual stabilization of the patient in the ED, coupled with extensive follow-up and wrap-around care to ensure treatment adherence. Truthfully, it would be easy enough to stabilize withdrawal with buprenorphine, but the critical piece that shows the most chance of success for this treatment structure involves the warm-handoff to care facilities upon discharge. With a current follow-up rate of 57% (compared to a national average of 20%), the success of this pathway relies heavily on a standard workflow, easy-to-understand patient resources, and strong communication between partnering facilities. The collaboration necessary to build this warm handoff included creating robust partnerships with community substance treatment providers; working closely with our central managing behavioral health entity; building partnerships with care facilities to treat co-occurring disease states (HIV/HCV); and internal collaboration with social work, case management, nursing, ED leadership, psychiatry, internal medicine, pain management, pediatrics, residents and attending physicians.


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