(Photo courtesy of UVM Health Network)
(JUNE 4, 2019) The state’s three University of Vermont (UVM) Health Network hospitals are expanding access to treatment for patients with opioid use disorder with the support of a $1.5 million federal grant. The grant will support expansion of a program to offer rapid access to Medication-Assisted Treatment (MAT), such as buprenorphine, for opioid use disorder in the hospitals’ emergency departments. The grant comes from the U.S. Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) branch.
Central Vermont Medical Center’s physicians began prescribing MAT in their Berlin emergency department last August; the UVM Medical Center began enrolling patients in its Emergency Department (ED) prescribing program in early February; and Porter Medical Center is in the planning stages of offering rapid access to treatment in its Middlebury emergency department.
“We know that when patients get onto medication assisted treatment, they stop dying, they can start to get their lives back,” said Daniel Wolfson, M.D., associate professor of surgery at UVM’s Larner College of Medicine and an emergency medicine physician. “The Emergency Department is in a unique position to help people who come to us with problems related to opioid addiction.”
In most EDs around the nation, patients who arrive after opioid overdose or poisoning are treated for the episode, and then referred to existing local treatment programs in the community for MAT. However, in the 24 to 72 hours it can take to get to a treatment center, patients are vulnerable to another overdose, death, or changing their minds about whether they’re ready to start treatment.
The new approach provides eligible patients with MAT to help them make it from the hospital to ongoing community treatment, where they will receive ongoing care through Vermont’s Hub and Spoke system.
“Vermont has made a lot of cutting-edge attempts to fight the opioid epidemic,” said Roz Bidad, BSN, project director for the grant. “But seeing the increase in deaths, despite those efforts, shows that we are still missing people. The goal of prescribing MAT in the ED is to catch people we have been missing and help them.”
While Vermont has responded to the opioid crisis aggressively – expanding access to care through the “hub and spoke” system, reducing the number of pills prescribed, making overdose reversal drug naloxone widely available, and exploring innovative approaches such as having peer recovery coaches on call to support patients – the number of drug-related fatalities in the state continues to increase. Additionally, only an estimated one-third of Vermonters who suffer from opioid use disorder are currently receiving treatment.
Because the program is being conducted as a study through the academic medical center, patients will be asked if they want to participate in the study, commit to treatment and follow up with researchers.
“We really want to be able to prove that this works,” said Stephen Leffler, M.D., an emergency medicine physician and UVM Health Network chief population health and quality officer. “What we hope to see is a lot of people being interviewed at the six-month mark, reporting no opioid use for the previous 90 days. Additionally, we hope to see fewer overdoses, recurrent ED visits and opioid-related deaths.”
Central Vermont Medical Center is currently prescribing MAT to patients in their ED, and this grant will help continue that work. “The Emergency Department is a door that is always open,” said Javad Mashkuri, M.D., medical director at CVMC. “By working together with our community partners, we have the opportunity to save lives because we know that someone who comes into our ED with an opioid overdose is at a much greater risk of dying from another overdose within the next 90 days. This grant will allow us to take the work we’ve done even further.”
“We are excited to be part of this innovative new approach to providing important services for our community,” said Carrie Wulfman, M.D., chief medical officer at Porter Medical Center in Middlebury. “We look forward to the planning process with our network colleagues and to rolling this program out in the coming months. By working together as a network, we can help many more Vermonters get the care they need.”
Evaluation data to assess the impact of the project will be collected by Richard Rawson, Ph.D., professor of psychiatry in the UVM Center for Behavior and Health.
“There’s a short window of time when someone might be in the emergency room, thinking about making a change and getting into treatment,” said Cam Lauf, supervisor of the Emergency Department Recovery Support Program at the Turning Point Center of Chittenden County. “Giving people the option to get started on treatment right at that moment is a good step,” Lauf said.
Both the UVM Medical Center and Central Vermont Medical Center have partnerships with peer recovery coaches, who are on call to spend time with patients who come in to the emergency department with substance use disorders. They discuss their options, support their choices to seek treatment, and even help make sure they get to follow-up appointments.
“Medication-Assisted Treatment saves lives,” said Sanchit Maruti, M.D., an assistant professor of psychiatry who directs the UVM Addiction Treatment Program that will receive patients who are inducted onto buprenorphine at the UVM Medical Center. “This approach will help more patients access sustained treatment for addiction and primary care for their overall health.”
Link to a special University of Vermont Health Network website dedicated to sharing information about the collaborative work being done in Vermont and Northern New York to confront the opioid crisis.