Evidence

Opioid use disorder is a strongly stigmatized, chronic relapsing disease; it is not a moral failing. People who present to the ED for other chronic diseases such as diabetes or asthma are stabilized with medication and linked to outpatient care. Individuals with OUD can overcome addiction with a similar treatment plan (National Institute on Drug Abuse).

Medication-assisted treatment (MAT) is the use of medications, in combination with counseling to treat opioid use disorder. Buprenorphine is one of the medications approved by the Food and Drug Administration (FDA) to treat opioid use disorder. As with all medications used in MAT, buprenorphine should be prescribed as part of a comprehensive whole-person approach treatment plan that includes other behavioral therapies and support systems (SAMHSA.gov).

EDs are a vital point of engagement for buprenorphine initiation and long-term linkage to treatment. A 2015 study (JAMA) found that twice as many patients in OUD treatment at least 30 days used less illicit opioids with an ED-initiated buprenorphine and a brief negotiation interview (BNI) compared with those who received a referral only or a BNI and facilitated referral.

Research has also found that patients who receive buprenorphine are less likely to overdose, die, use illicit opioids, spread hepatitis C virus or human immunodeficiency virus (HIV), and have fewer injection drug use complications and contacts with the criminal justice system.

Resources and Education for Emergency Departments

Screening and Assessment Tools

• Evidence Based Screening Tools and Assessment Resource Materials (National Institute on Drug Abuse)

Medication Assisted Treatment

• As of January 2023, a Buprenorphine Waiver (X-Waiver) is no longer required to treat patients with buprenorphine for opioid use disorder (OUD). Buprenorphine remains a Schedule III controlled substance and prescriptions for buprenorphine require a standard DEA registration number. There are no longer limits or patient caps on the number of patients a provider may treat for OUD with buprenorphine. The DEA released a letter to announce new training requirements that will go into effect June 21, 2023. DEA and SAMHSA are developing training requirement guidance.
  
• Buprenorphine Use in the Emergency Department Tool (American College of Emergency Physicians)
  
• Models for Implementing ED Initiated Buprenorphine (ACEP article)
  

Linkage to Treatment

• In Pennsylvania, local treatment programs are administered through county drug and alcohol offices called Single County Authorities in Pennsylvania. Single County Authorities coordinate care for individuals with Medicaid, are underinsured, or do not have insurance.
• Pennsylvania Centers of Excellence for OUD coordinate care for Medicaid.
• ATLAS: Addiction Treatment Locator, Assessment, and Standards Platform (Shatterproof)

Naloxone

• The Pennsylvania Department of Health's Physician General signed a standing order prescription for naloxone.
• Pennsylvania residents who purchase naloxone using their insurance might be eligible to receive up to $75 to assist with the out-of-pocket cost. Patients may visit their local pharmacy to learn more about the Naloxone Copay Assistance Program Certificate.
• If a patient does not have health insurance or if cost is a barrier, they may be able to receive free naloxone by mail. Through a partnership with the Pennsylvania Commission on Crime and Delinquency and NEXT Distro, anyone can get naloxone mailed to their home for free. Learn more about free naloxone by mail.
  
• Naloxone Product Fact Sheet (Pennsylvania Department of Health)

Safe Opioid Prescribing

• Pennsylvania Opioid Prescribing Guidelines (Pennsylvania Department of Health)
• Continuing Medical Education (Pennsylvania Department of Health