(101) Right Treatment Right Time: ED MOUD in a Single Safety-Net Hospital System

Background:
Medication for opioid use disorder (MOUD) is important for treatment and recovery from opioid use disorder (OUD). Many barriers exist to screening, initiation, and maintenance of MOUD treatment. Specifically, marginalized, underrepresented, and underserved populations, have limited access to care.(1) Low barrier access to MOUD through emergency departments (ED) is demonstrated to be safe, effective, and increase retention in treatment. (2, 3). JPS Health Network (JPS) is a publicly funded county hospital with community clinics, psychiatric services, and ED with >115,000 visits annually. The ED population has high substance use disorder, homelessness, and uninsured rates. JPS received a SAMHSA ED-ALT grant funding the Right Treatment Right Time (RTRT) project. RTRT uses an integrated network model which includes the ED, a Bridge Clinic, urgent care center (UCC), psychiatry, community, and street medicine clinics. RTRT provides screening, buprenorphine, naloxone distribution, with transition to long-term treatment providing a low barrier to MOUD.

Methods:
All eligible adult ED patients able to participate in care were screened for OUD using the opioid risk tool (ORT)(4) and clinician review. Clinically appropriate patients were offered MOUD in the ED. All OUD patients were referred to the Bridge Clinic for subsequent care, delayed initiation, care coordination, and peer support. Patients could self-refer or be referred by community partners. Access to care is 24/7 through ED, Bridge Clinic, and UCC. RTRT is staffed with a director, case manager, and peer navigator. Medical staff provides clinical care and prescriptions. “Bridge” patients are provided wrap-around services, peer support, medical care, and prescriptions until accepting referral is arranged (5).

Results:
From January 29 to Sept 30, 2021, 107 adult patients were enrolled in the program; each had at minimum one follow-up Bridge Clinic visit; 51 (48%) elected not to continue care, and 56 (52%) were referred to long term treatment. During the first 4 months of the program, clinic referrals were exclusively made to public and private centers. JPS office-based opioid treatment (OBOT) became available during month 5. Thereafter 34 (32%) were referred to OBOT. Retention for patients referred to OBOT at one month was 32 (94%) and 21 (62%) at month three. During the first nine months of the program, 14 patients were referred to OBOT, and eight (57%) remain in treatment after six months of treatment. Forty percent (40%) of patients stayed in-network when OBOT became available. We were unable to track patient retention at public and private clinics. Overall, 39 (36%) patients were lost to treatment, seven elected to taper off buprenorphine, three were incarcerated, one died, and one remains active in the Bridge Clinic.

Conclusion:
The RTRT program expands access to MOUD in a safety net health system providing care to an underserved population. Although RTRT was designed and initiated prior to release it is largely reflective of American College of Emergency Physicians (ACEP) consensus recommendations for OUD care in emergency departments. Although preliminary retention in treatment rates at 1, 3, and 6 months are high when patients elect to remain within hospital network for MOUD.

References: 1. Stein BD, Dick AW, Sorbero M, Gordon AJ, Burns RM, Leslie DL, et al. A population-based examination of trends and disparities in medication treatment for opioid use disorders among Medicaid enrollees. Substance abuse. 2018;39(4):419-25.
2. D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636-44.
3. D'Onofrio G, Chawarski MC, O'Connor PG, Pantalon MV, Busch SH, Owens PH, et al. Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention. J Gen Intern Med. 2017;32(6):660-6.
4. Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6(6):432-42.
5. Timko C, Schultz NR, Cucciare MA, Vittorio L, Garrison-Diehn C. Retention in medication-assisted treatment for opiate dependence: A systematic review. J Addict Dis. 2016;35(1):22-35.