Newsletters

POSTED: April 19th, 2018
POSTED IN: EM Pulse - The Official Newsletter of MOCEP, March/April 2018,

Patients routinely present to emergency departments seeking help with opioid withdrawal and — all too often — needing emergency resuscitation for opioid overdose.  ED physicians are uniquely positioned to literally change the life trajectory of patients who present to a hospital due to opioid dependence, and can serve as a portal to bring high-risk patients into treatment.  There is strong evidence to suggest that treatment of opioid misuse and dependence by physicians will significantly increase access to medication-assisted substance abuse treatment.[i] [ii]  

Specifically, utilizing evidence-based, Food and Drug Administration-approved medicines (e.g. buprenorphine) in the ED can have profound impact on patient engagement and connection to opioid use treatment services, and ultimately, reduce patient mortality.  In part, social bias and a pervasive view of addiction as a moral failing has limited access to effective, evidence-based treatments.

The Drug Addiction Treatment Act of 2000 establishes a program of waivers that allow qualified physicians to dispense or prescribe schedule III, IV, and V narcotic drugs approved by the FDA for the treatment of opioid dependence.  Approved by the FDA in 2002, buprenorphine became the first medication – and only approved medication to-date – for use under the DATA Waiver Program.  Unlike methadone treatment, which must be dispensed from a designated opioid treatment program, buprenorphine can be prescribed or dispensed in health care settings, significantly increasing treatment access.  Like methadone, careful regulations have been placed on buprenorphine as an Opioid Use Disorder treatment.  Qualified practitioners are required to acquire and maintain certifications to legally dispense or prescribe opioid dependency medications.

To receive a waiver to practice opioid dependency treatment with approved buprenorphine medications, physicians, nurse practitioners and physician assistants must notify the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment of their intent to practice this form of medication-assisted treatment and complete the required training curriculum.  The Missouri Hospital Association, in partnership with the Missouri College of Emergency Physicians, are supporting statewide efforts to increase buprenorphine access in health care settings.  MHA concurrently is aligned with the Missouri Department of Mental Health and the Missouri Institute of Mental Health to foster improved linkage and referral coordination through transitions of patient care to sustain buprenorphine maintenance at the community-level.  

Statewide participation in the DATA Waiver Program will augment Missouri’s efforts in providing evidence-based treatment of opioid dependence by increasing access to treatment for subgroups of patients who have historically lacked access to care.  Buprenorphine, in combination with behavioral therapies and recovery support services, provides a whole-patient approach to care coordination that is safe and effective. 

The Missouri State Targeted Response to the Opioid Crisis, in partnership with the Missouri Coalition for Community Behavioral Healthcare, are providing three, eight-hour MAT waiver trainings that will satisfy waiver prescribing requirements.  The following courses are provided in a blended format with four hours of classroom instruction and four hours of online work.

Saturday, May 12, 2018 – Half & Half Training, Columbia, Missouri

Click here to register.

 

Saturday, June 2, 2018 – Half & Half Training, St. Louis, Missouri
Click here to register.

Saturday, September 29, 2018 – Half & Half Training, Kansas City, Missouri
Click here to register.

References:

[i]American Society of Addiction Medicine. (2016). Sample office-based opioid use disorder policy and procedure manual. Retrieved April 10, 2018, from www.asam.org/docs/default-source/advocacy/sample-diversion-policy.pdf?sfvrsn=0

 

[ii]Milone, M.C. (2012). Laboratory testing for prescription opioids. Journal of Medical Toxicology, 8 (4), 408-416. Doi 10.1007/s13181-012-0274-7