Friday, February 9, 2018

#GetWaivered

A NEW APPROACH: MGH Emergency Department providers gather after receiving training.

With limited resources and access to treatments for addiction, emergency rooms across the country have become the first point of contact for many people with substance use disorders, but the lack of opportunity for follow-up leaves many emergency providers powerless when a patient is ready to begin their path to recovery. To better equip providers in the MGH Emergency Department (ED) with more substantial and evidence-based options for treating these patients, many at the MGH are changing where and when recovery begins.

The #GetWaivered program – introduced by Alister Martin, MD, a resident in Emergency Medicine, and Ali Raja, MD, executive vice chair of Emergency Medicine – encourages providers to participate in the training necessary to prescribe buprenorphine – a medication that curbs opioid cravings and reduces the effects of opioid withdrawal in the hopes of helping patients stay in treatment longer – usually only prescribed by addiction medicine specialists.

“We are under no illusions about what we are asking our folks to do – we are absolutely changing the way our specialty has approached this disease,” says Raja. “We have created a new protocol around initiating treatment for opioid addiction. It is important that we continue to support clinicians as they begin to screen for opioid use disorders and start patients on medication-assisted treatment.”

When Martin and Raja started the program in December, they hoped 5-10 providers would volunteer to take part in the program. But since its launch, 35-40 providers have received their waivers or are signed up for the training program.

“By the very nature of our work in the ED, we see a very selectedpopulation of opioid addicted patients – those in crisis, who have relapsed, some of whom have hit rock bottom and even those who have overdosed,” says Martin. “Based on what we see in the ED, we might wonder if our interventions will mean anything in the face of such an overwhelmingly destructive disease. We don’t see that, in fact, many people do recover.”

To prescribe buprenorphine, a “DEA X” waiver must be received from the U.S. Drug Enforcement Agency (DEA), the governing body that regulates and enforces controlled substance laws. Only once a letter of intent has been submitted and accepted, the training finished and the certification received, can someone prescribe buprenorphine.

Raja and Martin say they continue to work closely with staff at the MGH Substance Use Disorder Initiative Bridge Clinic, an outpatient clinic that works to treat and connect patients with substance use disorders to long-term, community-based treatment. Martin credits Sarah Wakeman, MD, medical director of the Substance Use Disorder Initiative, and Laura Kehoe, MD, MPH, medical director of the Bridge Clinic, as “incredible partners from the beginning, personally teaching our providers at every one of the waiver trainings.”

“The treatment of addiction in the ED is no longer a spectator sport,” says Martin. “If we are going to make a dent in this issue we have to each learn new ways of caring for patients and adapt our practice to meet the demands of this crisis.”To learn more, follow the team on Twitter at @GetWaivered.



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