Implementing a Novel Statewide Network to Support Emergency Department-initiated Buprenorphine Treatment

Abstract

Introduction: Medications for opioid use disorder (MOUD), including buprenorphine, represent an evidence-based treatment that supports long-term recovery and reduces risk of overdose death. Patients in crisis from opioid use disorder (OUD) often seek care from emergency departments (ED). The New York Medication for Addiction Treatment and Electronic Referrals (MATTERS) network is designed to support ED-initiated buprenorphine and urgent referrals to long-term care for patients suffering from OUD. Methods: Using the PRECEDE-PROCEED implementation science framework, we provide an overview of the creation of the MATTERS network in Western New York. We also include an explanation of how the network was designed and launched as a response to the opioid epidemic. Finally, we analyzed the program’s outputs and outcomes, thus far, as it continues to grow across the state. Results: The New York MATTERS network was created and implemented in 2019 with a single hospital referring patients with OUD to three local clinics. In the social assessment and situational analysis phase, we describe the opioid epidemic and available resources in the region at the outset of the program. In the epidemiological assessment phase, we quantify the epidemic on the state and regional levels. In the educational and ecological assessment, we review local ED practices and resources. In the administrative and policy assessment and intervention alignment phase, the program’s unique framework is reviewed. In the piloting phase, we describe the initial deployment of New York MATTERS. Finally, in the process evaluation phase, we depict the early lessons we learned. By the beginning of 2021, the New York MATTERS network included 35 hospitals that refer to 47 clinics throughout New York State. Conclusion: The New York MATTERS network provides a structured approach to reduce barriers to ED-initiated buprenorphine and urgent referral to long-term care. An implementation framework provides a structured means of evaluating this best practice model.

Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs

“…Future programmatic implementation should emphasize the education of existing addiction workforce staff on the evidence behind medication-first programs, in which provision of MOUD does not have restrictions or contingencies. 9 , 32 , 33 , 34 When considering research, clinical and policy implications, it is important to know that successful and smooth linkages are possible 6 , 11 , 35 ; however, health systems and programs must be flexible and accommodating, lowering barriers to entry to MOUD and addressing patients’ holistic needs. Linkage to care may be facilitated by recent regulatory changes.…”

“…Several referral options exist, including linking patients to clinicians in primary care sites, opioid treatment programs (OTPs), substance use disorder treatment centers, or bridge clinics for low-threshold buprenorphine. [9][10][11][12] However, 1 study 13 analyzing pharmacy claims data demonstrated that only 28.5% of patients receiving initial buprenorphine treatment in an ED setting filled a subsequent prescription for buprenorphine from a community-based clinician. Thus, to inform implementation efforts to promote ED-initiated buprenorphine with receipt of ongoing treatment, we explored perspectives of community-based clinicians and staff positioned to potentially receive ED-based referrals for ongoing OUD treatment.…”

“…However, patients receiving initial buprenorphine treatment in EDs face many potential barriers to ongoing MOUD in the community, and the linkage processes from EDs to community-based MOUD providers are not always effective. Several referral options exist, including linking patients to clinicians in primary care sites, opioid treatment programs (OTPs), substance use disorder treatment centers, or bridge clinics for low-threshold buprenorphine …”

“…Several referral options exist, including linking patients to clinicians in primary care sites, opioid treatment programs (OTPs), substance use disorder treatment centers, or bridge clinics for low-threshold buprenorphine. 9 , 10 , 11 , 12 …”