When patients with diabetes or high blood pressure present in the emergency department (ED), physicians can offer medications for treatment. For opioid-addicted patients, however, ED doctors are rarely able to offer the standard-of-care medication buprenorphine, despite its demonstrated efficacy in easing addiction’s grip. That is changing at the Massachusetts General Hospital (MGH) ED, which just became Massachusetts’ first to prescribe the medication—offering new hope for patients, and potentially saving lives.
The reasons for the relative scarcity of medication-assisted treatment (MAT) such as buprenorphine are complex. Addiction treatment may be given low priority in medical school curricula. Physicians who want to prescribe the drug must complete an eight-hour training course and secure a government waiver—and many have hesitations about working with addicted populations, as described recently in a moving essay by MGH primary care physician Audrey Provenzano. Residential treatment programs often ban the medication, furthering misconceptions that one drug should not treat another. Law enforcement officials worry that buprenorphine itself might become abused. But many experts say that the medication gives physicians a treatment tool when few are available, for a condition that can so instantly progress to death. One study showed that starting the drug in the ED led to a 50 percent better chance of treatment longevity.
To guide patients in that direction, MGH will offer the medication as part of a spectrum of treatments that also includes the hospital’s Bridge Clinic, which provides support for withdrawal symptoms; 55 primary care doctors waived to prescribe buprenorphine; and nurse practitioners and physicians educated in the nuances of addiction care, throughout the Partners HealthCare network.
With one physician trained in MAT protocol now available 24/7, the MGH ED is the first step on a path toward sustained, at-home addiction care, with physicians like Provenzano joining growing calls for reinforcements in the opioid addiction battle.
Read more about the MGH initiative and treatment protocol here.