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Maine Hospital Prescribing Medication For Substance Use Disorder In ER

Patty Wight
Maine Public
Dr. Ranjiv Advani (left), medical director of Mid Coast Hospital Emergency Department, and Dr. Leah Bauer, head psychiatrist of Mid Coast Hospital’s Addiction Resource Center.";

Until recently, the most that Mid Coast Hospital could do for patients showing up in the ER with opioid use disorder was to hand them a phone number to call for long-term help. But last fall, the hospital started something new in Maine and around the country — it started giving patients a dose of Suboxone, medication used to treat opioid addiction, and connecting them to other services.

Some patients show up at the emergency department at Mid Coast Hospital to ask for drug treatment. Others come because they’re experiencing a medical issue related to their opioid use, like an overdose. That’s what happened to Brian, who asked us not to use his last name.

“I was taking Suboxone illicitly off the street. In my addiction brain, it was the lesser of two evils,” he says. “Opiates got me in really bad places, and stuff. So I was doing that. I couldn’t find any. My friend said he could find some. We went in town, he ended up getting heroin. I never used heroin or needles like that before, and one time, I OD’d and ended up in the hospital.”

That was Mid Coast Hospital, where last Fall, the emergency department started taking a more hands-on approach with patients like Brian.

“In the past, what we would do would essentially be to refer people on to an outpatient center,” says Dr. Ranjiv Advani, the medical director of Mid Coast’s emergency department.

Advani says providers now do an assessment of patients with opioid use disorder. If they’re receptive to treatment, they get a dose of Suboxone. That’s important because it alleviates the symptoms of withdrawal.

“We know that if we don’t give some relief for that withdrawal, that there’s going to be a strong inclination to go back and use something that you might get your hands on, especially if it’s days or weeks until you can access treatment,” he says.

In addition to that first dose of Suboxone, patients also need a long-term program that can provide them with medication and psychosocial supports. So the ER teamed up with the hospital’s Addiction Resource Center to ensure patients could access treatment quickly.

Advani says most patients leave the ER with an appointment the next business day.

“The big thing is that link between the emergency department and the treatment center. If you don’t have that, you really can’t do something like this,” he says.

The idea was born out of a study by the Yale School of Medicine in 2015 that found that patients who were given Suboxone in the ER were more likely to stick with treatment than those who just got a referral.

The president-elect for the American Society of Addiction Medicine, Dr. Paul Earley, says prescribing medications for opioid use disorder is critical to improve the long-term prognosis for remission.

“The Maine hospital that’s beginning to prescribe treatment for opioid use disorders out of the emergency room is ahead of the curve,” he says.

Only a handful of other hospitals across the U.S. are doing the same thing. Dr. Leah Bauer, the lead psychiatrist for Mid Coast’s Addiction Resource Center, says some hospitals may be hesitant to start similar programs because of concerns that it will create a flood of patients seeking help — but she says that hasn’t happened at Mid Coast.

“There’s been a lot of patients screened that would be good candidates that haven’t taken us up on it, which has been another surprise,” she says.”

The referral program covers a range of substance-use disorders, and about two-dozen people have entered treatment through it. But less than half have opioid use disorder.

Bauer and Advani say it’s important to plant the seed for treatment, so that when someone is ready, they know where to go. That’s what happened to Brian. He returned to Mid Coast about a week after his overdose.

“This has been a life changer, and it holds me accountable,” he says.

Brian says he tried drug treatment in the past. But after the overdose nearly killed him, he decided to try again. He has three kids, including a toddler at home.

“The recovery is unimaginable. Every day you get blessed with something,” he says.

Bauer says other hospitals have contacted Mid Coast about its program, and she expects prescribing Suboxone in the ER to soon become the standard for care.