If you want to claim CME credit for listening to this podcast series, you must listen here: https://californiaacep.org/page/CalACEP-MAT-Podcast-Disclosure.

CalACEP MAT Podcast Episode 6: MAT FAQ

In the final episode of this series, our experts answer some of the most frequently asked questions about MAT. You should now have all the tools and information you need to get started with MAT in your ED. See the links below for more resources and reach out to California ACEP with any questions. Remember Kayce’s story and commit to saving a life!

If you enjoyed this podcast let us know! Connect with us on social media at @californiaacep.

Hosts:

Julia Magaña, MD, FAAP. Assistant Professor of Pediatric Emergency Medicine at UC Davis

Sarah Medeiros, MD, MPH, FACEP. Assistant Professor of Emergency Medicine at UC Davis

Guests:

Dr. Aimee Moulin, Associate Professor of Emergency Medicine at UC Davis and Past President of California ACEP

Dr. Hannah Snyder, Assistant Professor of Family Community Medicine and Associate Director of the Addiction Consult Team at UC San Francisco

Dr. Reb Close, Emergency Medicine Physician at Community Hospital of Monterey Peninsula

Resources:

California ACEP Medication Assisted Treatment Resources

California Bridge

“We’re developing hospitals and emergency rooms into primary access points for addiction treatment. This intensive program provides training and technical assistance to acute care providers to encourage patients to enter and remain in treatment.”

Substance Abuse and Mental Health Services Administration (SAMHSA) Medication-Assisted Treatment Resources

“The Game Has Changed”. Featuring Dr. Gail D’Onofrio. EM Pulse Podcast. 2018 March 15.

https://ucdavisem.com/2018/03/15/the-game-has-changed-episode-4/

Apply for your DEA-X Waiver!

SAMHSA

GetWaivered.com

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This series is a part of a chapter grant from the American College of Emergency Physicians (ACEP) and is made to compliment the online California ACEP MAT resources.

California ACEP is a wealth of information. Check out our website, californiaacep.org, where you’ll find resources beyond the MAT toolkit, including our mental health toolkit, ED violence prevention resources, human trafficking guidebook, safe prescribing guidelines for opioids, palliative care toolkit, PECARN decisions guides, and much more.

Thank you to Drs. Hannah Snyder, Aimee Moulin, and Reb Close for your expertise.

Also, a big thanks to Kelsey McQuaid for all of your hard work on this project.

EM Pulse is a podcast from the UC Davis Department of Emergency Medicine dedicated to bringing research and expert opinion to the bedside. Check it out and subscribe on iTunes, or wherever you get your podcasts. And follow us on social media @empulsepodcast.

Thanks to OM Audio Productions for audio production services.

References (from Dr. Snyder):

(https://discovery.cdph.ca.gov/CDIC/ODdash/).

Nationally, deaths from the opioid epidemic annually exceed those at the peak of the HIV epidemic. We've had more drug overdose deaths in 2017 than Americans that died in the entire Vietnam war (https://www.economist.com/briefing/2019/02/23/tens-of-thousands-of-americans-die-each-year-from-opioid-overdoses).

Here’s a cool graph that trends ED visits https://www.hcup-us.ahrq.gov/faststats/OpioidUseServlet?radio-3=on&location1=CA&characteristic1=01&setting1=ED&location2=US&characteristic2=01&setting2=ED&expansionInfoState=hide&dataTablesState=hide&definitionsState=hide&exportState=hide

Kashef Z. Starting opioid addiction treatment in the ED is cost-effective, says study. Yale News. August 16, 2017. Health media overview of landmark Yale MAT study and its effectiveness in guiding patients to treatment.

Initiating medication-assisted treatment for patients presenting with opioid withdrawal. ED Management. August 1, 2017. Health media overview of the effectiveness of MAT with a focus on the experiences of a program initiated in Washington state.

Emergency department initiation of medication-assisted treatment for opioid addiction: Strategies for success. California Health Care Foundation. Published August 2016. Report on launching an opioid addiction treatment program with visual guide to setting up an effective MAT program.

Emergency department treatment and follow-up strategies for opioid use disorder. Centers for Medicare & Medicaid Services. December 13, 2017. PowerPoint presentation outlining CMS-sponsored lectures on ED treatment and follow-up planning for patients presenting with opioid use disorder.

Robeznieks A. For patients struggling with opioids, ED visit can mark new start. AMA Wire. November 22, 2017. Brief AMA article outlining MAT therapy in the ED at Washington University Medical Center in St. Louis.

Frazier WT. Medication-assisted treatments and opioid use response to opioid overdose sentinel events. Master essay, University of Pittsburgh. Comprehensive overview of MAT response to opioid overdose to determine treatment utilization before and after nonfatal overdose using a longitudinal retrospective cohort of the Pennsylvania Medicaid population 2008-2013.

Martin A, Kunstler NM. Opinion: We have effective treatments for opioids addiction - why don’t we use them?” ACEPNow. December 12, 2017. Article on some barriers to the widespread adoption of MAT and a call to overcome these barriers for the sake of our patients.

Addressing the opioid crisis - an ACH collaboration. Washington State Hospital Association, Washington State Medical Association. Set of strategies outlined by the Accountable Communities of Health for communities, hospitals, and providers to better combat the opioid epidemic, of which MAT is a main component.

Research

D'Onofrio G, O'Connor PG, Pantalon MV, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015 Apr 28;313(16):1636-44. “The D’Onofrio Trial,” a randomized clinical trial performed at Yale showing the effectiveness of ED initiated MAT.

Does initiating medication assisted treatment in the emergency room result in better outcome? Recovery Research Institute. An organized breakdown and summary of the D’Onofrio study highlighting the effectiveness of ED initiated MAT.

Protocols

SBIRT and Buprenorphine/Naloxone Administration in the ED for Acute Withdrawal: St Agnes Hospital (PDF).

California ED-Bridge/ Emergency Buprenorphine Treatment Project: Guide for Emergency Buprenorphine Treatment (PDF).

ED Initiation of Buprenorphine in the Emergency Department: Natividad Medical Center (PDF).

Opioid Withdrawal Protocol: Zuckerberg San Francisco General Hospital and Trauma Center (PDF includes pocket card).