Start A Program

Checklist for Starting and ED MAT Program

  1. Confirm with hospital’s pharmacy director that buprenorphine is on the hospital formulary and available in the ED.
  2. Develop a connection with outpatient treatment facilities and providers who can receive patients referred from the ED. Treatment Locator or Rocky Mountain Crisis Partners (call 1-888-211-7766 and specify “opiate related call”) can help find the closest treatment partners.
  3. Train nurses, doctors and advance practice providers on assessing opioid withdrawal severity and administering buprenorphine. The Rocky Mountain Poison Center has trained clinicians ready to provide real-time guidance for assessing withdrawal and conducting buprenorphine inductions. Call 1-800-222-1222 and specify “ED buprenorphine induction support” to speak with a specialist at the Poison Center.
  4. Agree upon an easy, real-time protocol for clinicians. ColoradoMAT’s buprenorphine algorithm may serve this role or as a protocol that may be adapted for a hospital’s purpose.
  5. If possible, hire a recovery support specialist or substance use navigator to help patients transition to outpatient care. For hospitals without this capability, Rocky Mountain Crisis Partners offers free counseling and navigation to patients. Call 1-888-211-7766 and specify “opiate related call” to be connected with a specialist who will help connect patients with treatment providers.
  6. Create or adapt ColoradoMAT discharge materials and education materials for patients.
  7. Communicate to staff, patients, health care and community partners that your ED is providing MAT services.

In a recent study of over 150,000 National Health Service patients treated for opioid dependence, followed for a total of 442,950 patient years, treatment of opioid dependence with buprenorphine was found to reduce risk for opioid overdose death by one-half versus patients with no treatment or psychosocial treatment only.1

In a study of 33,923 Medicaid patients diagnosed with opioid dependence in Massachusetts, mortality during the four-year study period (2003-2007) was double among patients receiving no treatment versus patients treated with buprenorphine. Additionally, patients treated with buprenorphine experienced a 75% reduced mortality rate versus patients treated with psychosocial interventions alone.2

Among the highest risk patients who inject heroin, treatment with methadone or buprenorphine for at least five cumulative years is associated with a reduction in mortality from 25% at 25 years to 6%. The association between treatment and improved survival is likely multifactorial and mediated through reduced risk of HIV infection, improved social functioning, reduced criminality and establishing long-term contact with health professionals.3 4 5 6 7 8 9 10 Importantly, survival benefit is not affected by cessation of injection drug use.3

References

1 Pierce M, Bird SM, Hickman M, Marsden J, Dunn G, Jones A, and Millar T. Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction. 2016;111(2):298-308. doi:10.1111/add.13193.

2 Clark RE, Samnaliev M, Baxter JD, and Leung GY. The evidence doesn’t justify steps by state Medicaid programs to restrict opioid addiction treatment with buprenorphine. Health Aff (Millwood). 2011;30(8):1425-33. doi:10.1377/hlthaff.2010.0532.

3 Kimber J, Copeland L, Hickman M, Macleod J, McKenzie J, De Angelis D, and Robertson JR. Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment. BMJ. 2010;341(jul01 1):c3172-c3172. doi:10.1136/bmj.c3172.

4 Mattick RP, Breen C, Kimber J, and Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2:CD002207. doi:10.1002/14651858.CD002207.pub4.

5 Fugelstad A, Stenbacka M, Leifman A, Nylander M, and Thiblin I. Methadone maintenance treatment: the balance between life-saving treatment and fatal poisonings. Addiction. 2007;102(3):406-12. doi:10.1111/j.1360-0443.2006.01714.x.

6 Bell J, Trinh L, Butler B, Randall D, and Rubin G. Comparing retention in treatment and mortality in people after initial entry to methadone and buprenorphine treatment. Addiction. 2009;104(7):1193-200. doi:10.1111/j.1360-0443.2009.02627.x.

7 Gowing L, Farrell M, Bornemann R, and Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection. The Cochrane Library. 2004.

8 Amato L, Davoli M, Perucci CA, Ferri M, Faggiano F, and Mattick RP. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research. J Subst Abuse Treat. 2005;28(4):321-9. doi:10.1016/j.jsat.2005.02.007.

9 Sporer KA. Strategies for preventing heroin overdose. BMJ. 2003;326(7386):442-4. doi:10.1136/bmj.326.7386.442.

10 Ward J, Hall W, and Mattick RP. Role of maintenance treatment in opioid dependence. Lancet. 999;353(9148):221-6. doi:10.1016/S0140-6736(98)05356-2.