54 An Emergency Department-Based Medication-Assisted Treatment Pathway for Opioid Use Disorder That Does Not Require a Data 2000 Waiver

Abstract

There is increasing recognition that the ED can play a central role in ending the ongoing opioid epidemic following publication of a successful medically assisted therapy (MAT) pathway that relied on ED providers to initiate buprenorphine followed by linkage to care for treatment of patients with opioid use disorder (D’Onofrio 2015). However, buprenorphine prescribing requires a DEA waiver. Additionally, linkage challenges specific to this patient population may hinder rapid scale up of ED based MAT programs. We created a MAT pathway in our ED that does not require buprenorphine prescribing waivers in partnership with a specific substance abuse treatment facility in order to increase provider buy-in and availability to patients of pathway resources. We initiated our pathway in September 10, 2018 and have enrolled 55 patients as of April 1, 2019. 52% of our patients have followed up with our substance abuse treatment facility partner. Of those, over 50% are still stable and in treatment. Current law allows physicians to order buprenorphine for patients in acute opioid withdrawal while in the hospital over a 72-hour period. We implemented the Clinical Opioid Withdrawal Scale (COWS) into our routine ED practice. COWS requires patient interview to assess engagement which was done either by the treating physician, a social worker or, at time of early implementation, a research assistant. Patients with a COWS score of >=5 were offered buprenorphine in the ED and linkage was initiated to our treating partner via a HIPAA protected email system and with a printed referral form co-designed by our ED and our treating partner. Patients then had 24 hours (half-life of buprenorphine) to present at the treatment facility. Transportation costs were covered when needed through our substance treatment partner via federal and state funding. Drug cost (ie, buprenorphine or methadone) was also covered when appropriate. Buprenorphine stabilization for opioid use disorder in the ED is now an integrated part of clinical workflow and provides a treatment structure for a challenging patient population that often require care extending beyond an acute clinical encounter. This nascent ED MAT pathway has demonstrated early success with high provider buy-in by decreasing barriers to implementation and utilization, including the need for a buprenorphine waiver and challenges in patient follow up.