Pennsylvania Substance Use Navigation (PA-SUN)
Get Involved |
Resources for Emergency Departments |
Screening and Assessment Tools |
Medication Assisted Treatment |
Linkage to Treatment |
Learning Opportunities |
The Pennsylvania Substance Use Navigation (PA-SUN) Program began as a statewide pilot designed to enhance treatment options for patients with opioid use disorder (OUD) by increasing access to medication-assisted treatment (MAT) using Food and Drug Administration-approved medication for the treatment of OUD in Emergency Departments (EDs).
PA-SUN aimed to reduce opioid overdose deaths by:
- Increasing the number of EDs that are prepared to initiate buprenorphine, prescribe or dispense naloxone, and facilitate linkage to treatment, and
- Reducing barriers and supporting clinical quality improvement.
The Department offered EDs in Pennsylvania the opportunity to receive free technical assistance, consultation, and support from expert opioid medical consultant clinicians with OUD treatment knowledge to optimize care for patients with OUD.
The PA-SUN pilot included
54 hospitals throughout the Commonwealth with participation in, 93 technical assistance consultations to prescribers and health teams on topics including, but not limited to, naloxone distribution and linkage to care. PA-SUN also provided a total of 7,008 doses of free naloxone to EDs for distribution to patients. The PA-SUN pilot officially ended on August 31, 2023, and developed into a new funding opportunity for emergency departments in Pennsylvania.
NOW ACCEPTING APPLICATIONS: The PA-SUN Request for Applications (RFA) is now open. Hospitals and Health Systems, on behalf of their ED(s), are invited to submit an application to the Department in accordance with RFA # 67-166.
Through this RFA, the Department is soliciting ED navigation and linkage to care applications for the PA-SUN Program. The Department is interested in funding applications addressing building and implementing health system-wide clinical capacity to screen, diagnose, and support longitudinal care for opioid use disorder (OUD) and stimulant use disorder (StUD) and support recovery for adults and adolescents. The overall goal of this funding is to promote and support ED linkage to care via multidisciplinary teams including navigators, broadening the scope from only post-overdose scenarios to also include strategies like focused connections during care for conditions that may represent sequelae of substance use, and enhanced universal screening for substance use disorder (SUD) among patients presenting for other reasons to EDs to identify new opportunities to engage in and link to care.
All questions regarding this RFA must be directed by e-mail to firstname.lastname@example.org, no later than 12:00 p.m. on December 4, 2023. All questions must include the specific section of the RFA about which the potential applicant is requesting clarification. Answers to all questions will be posted at www.emarketplace.state.pa.us. Click on 'Solicitations' and search for the above RFA number. Applications must be received no later than 1:30 p.m. on January 16, 2024.
Free Continuing Education: By end of year 2023, the PA-SUN team intends to release asynchronous (self-study) education modules to aid EDs in increasing knowledge on topics such as harm reduction, buprenorphine initiation, linkage to care, and stigma.
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 for Emergency Departments
Screening and Assessment Tools
Medication Assisted Treatment
- As of January 2023, a Buprenorphine Waiver (X-Waiver) is no longer required to treat patients for 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
- 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)
- The Pennsylvania Overdose Prevention Program (POPP), a joint initiative between PCCD and the Pennsylvania Department of Drug and Alcohol Programs (DDAP),
offers multiple formulations of naloxone as well as drug checking strips designed to detect xylazine and fentanyl at no cost to individuals and organizations across Pennsylvania including EDs. EDs may learn more about obtaining naloxone through this initiative by visiting the
POPP website or contacting PCCD staff at:
- Emergency Departments can play a vital role in distributing naloxone to patients. PA DOH developed a Naloxone Distribution in Emergency Departments Guide to promote naloxone distribution successes in Emergency Departments in Pennsylvania.
Learning Opportunities (CME and non-CME)
EDs may also play a vital role in the reduction and management of health risks related to patients who report injection drug use.