A rapid access to addiction medicine clinic facilitates treatment of substance use disorder and reduces substance use

Abstract

Background: Substance use is prevalent in Canada, yet treatment is inaccessible. The Rapid Access to Addiction Medicine (RAAM) clinic opened at the University Health Network (UHN) in January 2018 as part of a larger network of addictions clinics in Toronto, Ontario, to enable timely, low barrier access to medical treatment for substance use disorder (SUD). Patients attend on a walk-in basis without requiring an appointment or referral. We describe the RAAM clinic model, including referral patterns, patient demographics and substance use patterns. Secondary outcomes include retention in treatment and changes in both self-reported and objective substance use. Methods: The Electronic Medical Record at the clinic was reviewed for the first 26 weeks of the clinic's operation. We identified SUD diagnoses, referral source, medications prescribed, retention in care and self-reported substance use. Results: The clinic saw 64 unique patients: 66% had alcohol use disorder (AUD), 39% had opiate use disorder (OUD) and 20% had stimulant use disorder. Fifty-five percent of patients were referred from primary care providers, 30% from the emergency department and 11% from withdrawal management services. Forty-two percent remained ongoing patients, 23% were discharged to other care and 34% were lost to follow-up. Gabapentin (39%), naltrexone (39%), and acamprosate (15%) were most frequently prescribed for AUD. Patients with AUD reported a significant decrease in alcohol consumption at their most recent visit. Most patients (65%) with OUD were prescribed buprenorphine, and most patients with OUD (65%) had a negative urine screen at their most recent visit. Conclusion: The RAAM model provides low-barrier, accessible outpatient care for patients with substance use disorder and facilitates the prescription of evidence-based pharmacotherapy for AUD and OUD. Patients referred by their primary care physician and the emergency department demonstrated a reduction in median alcohol consumption and high rates of opioid abstinence.

Mortality among patients with frequent emergency department use for alcohol-related reasons in Ontario: a population-based cohort study

“…[32][33][34] Promising strategies include screening, brief intervention, treatment referrals, 35 managed alcohol programs 36 and case management. 37 Rapid access to addiction medicine clinics has been shown to reduce both substance use 38 and emergency department visits, 39 and may also have an impact on mortality in frequent users of emergency departments for alcohol-related mental and behavioural disorders. ‡Decreasing frequency with increasing ED use; not statistically significant.…”

Facilitating rapid access to addiction treatment: a randomized controlled trial

“…The preliminary results of this trial led to the creation of the Mentoring, Education, and Clinical Tools for Addiction: Primary Care-Hospital Integration (META:PHI) project, a provincial initiative to spread this rapid access model of addiction care. Some of the clinics created following this initiative have demonstrated positive patient outcomes [25][26][27]. There are several ways that on-site and immediate access can be accomplished in addition to rapid access clinics.…”

A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department

“…Having outpatient clinics available addresses concerns of initiating a chronic medication in an acute setting, titrating the dose, and providing ongoing care. Rapid access clinics demonstrate positive clinical outcomes and retention in care, forming a crucial component of ED-initiated treatment for OUD [ 9 , 29 ]. ED leadership should work closely with outpatient clinics to ensure rapid follow-up and a smooth transition of care from the ED to the outpatient clinic.…”

“…Buprenorphine is increasingly accessible in Ontario after being included on the Ontario Drug Benefit formulary [ 6 ]. Buprenorphine induction in the ED has been shown to be a feasible and effective approach to begin medication for addiction treatment [ 7 – 9 ]. A randomized clinical trial found that ED-initiated buprenorphine significantly increased engagement in addiction treatment and decreased use of inpatient addiction services compared to referral or brief interventions in the ED [ 7 ].…”