Massachusetts General Hospital (MGH) is taking a stand against the opioid epidemic with medication-assisted treatment (MAT), but not in the way you would think. Doctors at MGH have completed courses to be able to prescribe buprenorphine to opiate addicts. The doctors haven’t stopped there in their efforts to help save lives. They have opened Massachusetts General Hospital Bridge Clinic to offer outpatient services to those seeking treatment for their substance use disorders. Combining MAT access round the clock to patients entering the emergency department and offering continuing care MGH is fighting the opioid epidemic with a new approach.
MAT and Emergency Departments
People struggling with substance use disorders often meet with medical professionals in emergency rooms. Those struggling with substance use disorders make up 9% of the yearly hospital population. Whether patients be at the hospital for an overdose or issues related to IV drug use such as abscesses, it’s one of the only times addicts seek medical attention. At most hospitals, the only option is to treat the immediate issue at hand. There is no medication offered to curb withdrawals or to control addiction. At most, addicts are given a list of numbers for detoxes and possibly assistance in making the phone calls.
Doctors at MGH are changing this protocol. There will be a doctor who has had the appropriate training and federally obtained waiver to prescribe buprenorphine on staff in the emergency department (ED) 24/7. People struggling with opiate use disorders are the specific focus of this change at MGH. Dr. Gail D’Onofrio – the chair of the Department of Emergency Medicine at Yale-New Haven Hospital, the first ED to offer MAT- stated, “The thing about opiate addiction and overdose is it just takes one and someone will die because fentanyl and other synthetic opioids are so potent. It’s very scary. If we have someone in front of us who has this problem and this disease, we need to start initiating treatment immediately. We can’t wait.”
What is the Goal for MAT in the Emergency Department?
The goal with offering MAT started in the ED, will help patients transition into home-based continuous care. Normally, patients who are seeking treatment would have to look for a doctor to prescribe them buprenorphine, and the wait can take months to be seen. It is also costly. For some patients, the 2-day supply is enough to not resort to drug use long enough to get into an inpatient treatment center, if that’s the path they want to take. With this plan, and the accompanying Bridge Clinic, MGH is hoping patients will continue with MAT and integrate back into life at home.
Not all patients coming through the ED are given the prescription for buprenorphine. Poor prescribing habits wouldn’t help the opioid crisis it would only fuel it. Every patient that comes into the ED and asks for treatment or shows signs of opioid addiction will be assessed and if appropriate, be given a 2-day supply of buprenorphine. The patients are also given an informational sheet with explicit directions on how to take the buprenorphine. Not only are there clear directions on the sheet, but there’s also information about the MGH Bridge Clinic at the bottom of the page.
Medication Assisted Treatment and the Bridge Clinic
The Bridge Clinic is a small program that is open 9-5, 7 days a week. The Bridge Clinic tries to meet people where they are at. For patients, this means if they are coming in still actively using substances, or suffering from withdrawals, the Bridge Clinic will help. Unlike most clinics that will refuse patients for showing up late to appointments, had insurance lapses, or had shown signs of relapse or admitted to relapsing, the Bridge Clinic doesn’t require any of those things. The Bridge Clinic is full of resources, medical staff and offers various options for whatever path to recovery the patients choose.
Some patients want to start MAT as soon as possible. Either coming in from MGH with a 2-day supply, or off the streets but cannot afford to leave work for traditional substance use treatment. The Bridge Clinic can offer this as well as assist patients in finding other resources, such as housing and reinstating state health insurance. Insurance can help pay for medications to treat mental health disorders. Finding sober living can greatly help in conjunction with attending groups at the Bridge Clinic.
How will MAT and the Bridge Clinic Help?
Those who struggle with substance use disorders will often have moments of clarity where they are willing and ready to seek treatment. Unfortunately, it is usually in times of trouble, such as following an overdose or a negative experience. The time frame for positive action like seeking treatment is often a very small window of opportunity for most people. Most emergency departments can’t prescribe MAT to patients. Not having addiction treatment options, many patients to go back to active substance use to curb withdrawal symptoms. Having this flow of care from the emergency room, to MAT and ultimately to the Bridge Clinic, gives patients access to treatment at their fingertips.
When it comes to opioid use disorder, it is a matter of life and death every time drugs are used. With the increase in overdose deaths, Massachusetts General Hospital took a new approach to how they were going to help their community and those struggling with substance use disorders. MAT is a standard of care that has saved many lives, for those struggling with substance use disorders, starting MAT as soon as possible can assist those struggling with an abstinence-based treatment approach, from relapsing. MGH is giving another option for those who are still struggling or want to try a different approach to treatment and truly operates with compassion and empathy.