In early October, St. Joseph’s University Medical Center Emergency Department in Paterson, New Jersey, became the first facility in the nation to earn the new ACEP Pain and Addiction Care in the Emergency Department (PACED) accreditation. This new accreditation program is another important piece of ACEP’s efforts to combat the opioid crisis.

First PACED Accreditation

ACEP’s PACED program launched in early 2020 and is the first of its kind to recognize emergency departments that specialize in safe and effective pain and addiction treatment while minimizing the use of opioids or prioritizing alternatives to opioids. PACED-accredited facilities will accelerate the implementation of best practices nationwide and collaborate to help ensure that emergency physicians have the resources, protocols, and training necessary to provide the highest-quality pain and addiction management.

It’s fitting that the program’s first accreditation was awarded to the hospital that began the landmark Alternatives to Opioids (ALTO) program back in 2016.

“Although we have made important strides in emergency department pain and addiction care, the opioid crisis continues to ravage our communities. PACED accreditation offers a structure for frontline staff and administrators to work together to ensure the safest evidence-based care is available for their entire community,” said Alexis M. LaPietra, DO, FACEP, chief of pain management/addiction medicine at St. Joseph’s University Medical Center.

PACED was created to benefit all three stakeholders involved: the patients, the emergency care team, and the hospitals. Importantly for emergency physicians, the program serves to accelerate the implementation of best practices while providing a structure that ensures emergency physicians have the resources and training to provide optimal pain and/or addiction management.

The program features three levels: Bronze, Silver, and Gold. The Bronze level is within reach of every hospital, and the Silver and Gold levels have higher standards that require more focused effort and resources. Learn more about this innovative new program and its accreditation requirements. 

X-Waiver Training

COVID-19 has created new barriers to care, and the isolation of the pandemic has affected patients with addiction. Many clinics are reducing hours and limiting the intake of new patients. For many, the emergency department is the only source of treatment for opioid use disorder (OUD).

ACEP has been offering free, live X-waiver trainings on the Zoom platform throughout 2020. At the time this was published, ACEP had recorded 1,287 trainings through its Zoom courses this year. Though the curriculum was developed by emergency physicians, the courses are open to a broad audience. There are still opportunities for you attend a training; learn more.

Ongoing OUD Advocacy

For years, ACEP’s advocacy team has been working on legislative and regulatory issues related to the opioid crisis. In October 2018, President Donald Trump signed a sweeping legislative package of bills to address the nation’s growing opioid epidemic, with former ACEP Executive Director Dean Wilkerson in attendance at the signing ceremony. Included in the package were the Alternatives to Opioids (ALTO) in the Emergency Department Act and the Preventing Overdoses While in Emergency Rooms (POWER) Act, both of which ACEP developed with the sponsoring members of Congress.

The ALTO in the Emergency Department Act (HR 5197/S 2516) established a demonstration program to implement nonopioid evidence-based pain management protocols, such as nitrous oxide, trigger-point injections, nerve blocks, and other pain management options, in hospitals across the country, based on the successful and proven ALTO program developed in New Jersey and recently implemented in several hospitals in Colorado.

The Preventing Overdoses While in Emergency Rooms (POWER) Act (HR 5176/S 2610) provides grants to establish policies and procedures for initiating medication-assisted treatment (MAT) in the emergency department. It also provides education and additional resources to help implementation of MAT in the emergency department as well as to develop best practices to provide a “warm handoff” to appropriate community resources and health care workers to keep patients engaged in treatment. MAT is a proven medical treatment that can relieve withdrawal symptoms and psychological cravings of OUD.

The first grants for these critical programs were made available in 2020, ensuring that federal resources can help support and expand emergency medicine’s important efforts to address the nation’s opioid crisis. Additionally, ACEP continues working with the sponsors of these laws to secure continued appropriations funding to ensure a stable funding stream for the grant programs.

As the opioid crisis continues to grow during the COVID-19 pandemic, ACEP continues working to permanently remove many of the barriers to OUD treatment, including substantial regulatory and legislative advocacy for changes that make it easier for emergency physicians to initiate MAT in the emergency department. We believe that the federal X-waiver requirement that mandates physicians take an eight-hour course and receive a Drug Enforcement Agency waiver to be able to prescribe buprenorphine outside of opioid treatment programs is a significant barrier to treatment. The presence of this X-waiver requirement has led to a misperception that buprenorphine is fundamentally different from other medications—including narcotics—that physicians are trained to prescribe. As a result, some physicians have been hesitant to pursue the waiver or engage in treatment of patients with OUD at all. We support HR 2482, the Mainstreaming Addiction Treatment Act of 2019, which would remove the X-waiver requirement.

On the regulatory side, ACEP strongly supports a modification to the current “three-day rule,” which requires health care workers to administer buprenorphine one day at a time and forces patients to come back each day to receive treatment in the emergency department or other care settings. Emergency departments (even without having clinicians with X-waivers) should be able to dispense a three-day supply of buprenorphine or administer a dose that will last for at least three days. There is also legislation that would address the three-day rule. ACEP supports H.R. 2281, the “Easy Medication Access and Treatment for Opioid Addiction Act.” Reimbursement of MAT has been an issue, and through ACEP’s advocacy, Medicare will start reimbursing for MAT in the emergency department in 2021.

Learn more about ACEP’s advocacy work related to opioid use disorder.

Ms. Grantham is ACEP’s communications manager.