“The ED where this study took place had access to a primary care clinic that provided buprenorphine–naloxone treatment regularly and access to near-term appointments,” Dr. Busch said. “Some EDs may not have similar primary care or other providers that can provide ongoing buprenorphine with appointments available in their vicinity. National efforts to increase access to outpatient buprenorphine treatment, including expanding treatment capacity of providers and expanding prescribing to nurse practitioners, should make it easier for EDs to provide this treatment.”
Dr. Marc Fishman from Johns Hopkins University, Baltimore, who recently reviewed the treatment of opioid use disorders, told Reuters Health by email, “This body of work (the current article about the cost-effectiveness analysis of the study and, more important, the original report of the main findings of the study) is a landmark in addiction treatment delivery systems. The dramatic result is the demonstration of impressive effectiveness of efforts to improve linkages to specialty addiction treatment for patients presenting at general medical treatment touchpoints, namely the ED.”
“Currently, only a minority of patients in need find their way to specialty addiction treatment, and when they do, it tends to be late in their course after considerable progression to very high severity and chronicity,” he said. “So interventions that take advantage of the motivational moment of a crisis-driven ED visit to move patients earlier to addiction treatment are highly effective and cost-effective. Furthermore, although not surprising, it is important to verify that ED-initiation of buprenorphine with a warm handoff to ongoing treatment is the more effective linkage strategy.”
“EDs will have to establish procedures for managing these patients, seeing buprenorphine initiation as a vital, lifesaving ‘emergency’ procedure and accepting the slowdown in throughput,” Dr. Fishman said. “Equally important will be identifying community capacity for ongoing treatment and establishing collaborative relationships with community specialty addiction providers who can serve as a ‘back door.’”
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3 Responses to “ED-Initiated Buprenorphine Cost-Effective for Opioid Dependence”
September 10, 2017
Timothy H OmleyThis is true of any treatment of any illness: “access to a providing clinic, and near appointment follow-up”. No study was needed for that conclusion.
September 10, 2017
Larry A. Bedard, MD, FACEPMedicinal Cannabis is also effective in helping opioid dependent
people reduce or eliminate their use of opioids.
There are drug treatment centers who use methadone, buprenorphine and medical cannabis for trading opioid dependency.
I wonder how many emergency physicians exercise their First Amendment Right and recommended cannabis for chronic pain, chemotherapy induced nausea and multiple sclerosis.
September 14, 2017
AC MDStudies such as these fail to reflect the realities on the ground for most hospitals and the healthcare system at large. It is helps soothe us into neglecting the greater effort of finding out why we as a country have the highest drug use rates in the world. Patient after patient comes in from every socioeconomic background essentially telling me their right to engage in using everything from cocaine to opioids for “recreation”. It is their rite of passage in college or business trip social gatherings. When these patients become addicts despite our warnings, society rings its hands and says we have an epidemic, a country in the throes of a terrible disease. Of course there are those who fell into the addiction morass because of our opioid over prescribing (also fueled by studies that told us how woefully mismanaged our pain care was, a missed “vital sign”). There are those who succumbed due to socioeconomic circumstances. However, how does that explain the 20-year old suburbanite who was bored and got hooked? These backend ED approaches are no different than take home goodie bags of narcan and the STD tx rx we give to patients’ sexual partners who we never lay eyes on and whose allergies are never reviewed. Never mind that the underlying issue of how why or how this person has an STD is never adequately addressed and that it sets a precedent of infantilizing patients.
People often come to the ED because of predictable yearly limited to nonexistent access to primary care providers, specialists and mental health providers. We have truly limited resources to meet the care of a rapidly aging population who will need more homecare, medications and nursing home care than any group in history. We have obesity bringing diabetes, hypertension and orthopedic troubles to younger populations. It is commonplace to see a person in their 30s tell you about their CPAP machine. Even if our healthcare systems were not plagued by the uncertainties of political rancor and discordant priorities we still would still face limited access to all areas of healthcare including ancillary support. If you’re in a rural area, good luck, it’s even worse. It is time we look at ourselves and patients as part of an entire system with limited resources and realize that we are reaching a point where there is either money for mom’s chemotherapy or payment for twenty people to get a couple months of opioid treatment. They are both serious healthcare needs so why don’t we address that instead, starting at the assumption compromise will be needed.
So yes, let us publish another article about what an academic center can do in a controlled study and have this splashed on the major news networks sites (this usually gets picked up by an online newsfeed) so our patients can come in and ask for a drug I know many of them abuse already. Let’s talk about if we only put more money into various resources how we can change things even though we spend more per capita on healthcare with worse results across the board. Let’s make this another standard of care so we feel we’ve made a difference when it will in the end only help us feel better. I’m sorry, but this does nothing to educate or help ED providers. I want to hear about better models of prevention not how a tightly controlled study that can’t be widely replicated without taking health resources from another group (we have millions struggling with opioid addiction) worked so well.