Multi-site intervention to improve emergency department care for patients who live with opioid use disorder: A quantitative evaluation

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 784-792 ◽  
Author(s):  
Patrick McLane ◽  
Ken Scott ◽  
Zainab Suleman ◽  
Karen Yee ◽  
Brian R. Holroyd ◽  
...  
Keyword(s):  
Emergency Department ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Emergency Department Care ◽  
Improvement Project ◽  
Health Crisis ◽  
Opioid Agonist Treatment ◽  
Before And After ◽  
Disorder Treatment

ABSTRACTBackgroundOpioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.MethodsThe intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.ResultsThe intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.ConclusionsEmergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.

scholarly journals Initiating Buprenorphine/Naloxone for Opioid Use Disorder in the Emergency Department

2020 ◽  
Vol 43 (1) ◽  
pp. 12-22
Author(s):  
Keysha Low
Keyword(s):  
Emergency Departments ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Health Crisis ◽  
Multifaceted Approach ◽  
Public Health Crisis ◽  
Recommended Treatment ◽  
Disorder Treatment ◽  
The Impact

The opioid crisis continues to affect individuals across the country, and requires a multifaceted approach to minimize the impact of this public health crisis. Through the chronic consumption of opioids, many individuals can become dependent on opioids and develop opioid use disorder. Buprenorphine/naloxone is the recommended treatment for patients living with opioid use disorder. The Emergency Strategic Clinical Network™ within Alberta Health Services is targeting the crisis through emergency departments by implementing a provincially standardized program. The Buprenorphine/Naloxone Initiation in Emergency Departments program includes screening for opioid use disorder, treatment initiation with the medication buprenorphine/naloxone, and providing rapid and reliable referrals to community clinics for titration and continuing patient care. This paper provides an overview of opioids, opioid use disorder, opioid agonist treatments such as buprenorphine/naloxone, and specifically details the program and protocol available in Alberta.

scholarly journals Opioid agonist treatment and fatal overdose risk in a state‐wide US population receiving opioid use disorder services

Addiction ◽  
2020 ◽  
Vol 115 (9) ◽  
pp. 1683-1694 ◽  
Author(s):  
Noa Krawczyk ◽  
Ramin Mojtabai ◽  
Elizabeth A. Stuart ◽  
Michael Fingerhood ◽  
Deborah Agus ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Fatal Overdose

scholarly journals Take Home Injectable Opioids for Opioid Use Disorder During and After the COVID-19 Pandemic Is in Urgent Need: A Case Study

2020 ◽  
Author(s):  
Eugenia Oviedo-Joekes ◽  
Scott MacDonald ◽  
Charles Boissonneault ◽  
Kelli Harper
Keyword(s):  
Addiction Treatment ◽  
Risk Mitigation ◽  
Opioid Use Disorder ◽  
Negative Consequences ◽  
Opioid Use ◽  
Regulatory Structure ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
First Case ◽  
Opioid Medications

Abstract Background: In North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they’re financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT.Case Presentation: Here we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics. Conclusion: In the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.

scholarly journals Using routinely collected data to understand and predict adverse outcomes in opioid agonist treatment: Protocol for the Opioid Agonist Treatment Safety (OATS) Study

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e025204 ◽  
Author(s):  
Sarah Larney ◽  
Matthew Hickman ◽  
David A Fiellin ◽  
Timothy Dobbins ◽  
Suzanne Nielsen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Treatment Protocol ◽  
Health Data ◽  
Adverse Outcomes ◽  
Learning Approaches ◽  
Emergency Department Presentation ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Routinely Collected Health Data

IntroductionNorth America is amid an opioid use epidemic. Opioid agonist treatment (OAT) effectively reduces extramedical opioid use and related harms. As with all pharmacological treatments, there are risks associated with OAT, including fatal overdose. There is a need to better understand risk for adverse outcomes during and after OAT, and for innovative approaches to identifying people at greatest risk of adverse outcomes. The Opioid Agonist Treatment and Safety study aims to address these questions so as to inform the expansion of OAT in the USA.Methods and analysisThis is a retrospective cohort study using linked, routinely collected health data for all people seeking OAT in New South Wales, Australia, between 2001 and 2017. Linked data include hospitalisation, emergency department presentation, mental health diagnoses, incarceration and mortality. We will use standard regression techniques to model the magnitude and risk factors for adverse outcomes (eg, mortality, unplanned hospitalisation and emergency department presentation, and unplanned treatment cessation) during and after OAT, and machine learning approaches to develop a risk-prediction model.Ethics and disseminationThis study has been approved by the Population and Health Services Research Ethics Committee (2018HRE0205). Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely-collected health Data statement.

scholarly journals A Cohort Study Evaluating the Association Between Concurrent Mental Disorders, Mortality, Morbidity, and Continuous Treatment Retention for Patients in Opioid Agonist Treatment (OAT) Across Ontario, Canada Using Administrative Health Data

2020 ◽  
Author(s):  
Kristen A Morin ◽  
Joseph K Eibl ◽  
Graham Gauthier ◽  
Brian Rush ◽  
Christopher Mushquash ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Opioid Use Disorder ◽  
Treatment Retention ◽  
Continuous Treatment ◽  
Drug Benefit ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Using Data

Abstract Background: Due to the high prevalence of mental disorders among people with opioid use disorder, the objective of this study was to determine the association between concurrent mental disorders, mortality, morbidity and continuous treatment retention for patients in opioid agonist treatment in Ontario, Canada. Methods: We conducted a retrospective cohort study of patients enrolled in opioid agonist treatment between January 1, 2011, and December 31, 2015. Patients were stratified into two groups: those diagnosed with concurrent mental disorders and opioid use disorder and those with opioid use disorder only, using data from the Ontario Health Insurance Plan Database, Ontario Drug Benefit Plan Database. The primary outcome studied was all-cause mortality using data from the Registered Persons Database. Emergency Department visits from the National Ambulatory Care Database, hospitalizations Discharge Abstract Database, and continuous retention in treatment, defined as one year of uninterrupted opioid agonist treatment using data from the Ontario Drug Benefit Plan Database, were measured as secondary outcomes. Encrypted patient identifiers were used to link information across databases.Results: We identified 55,924 individuals enrolled in opioid agonist treatment, and 87% had a concurrent mental disorder diagnosis during this period. We observed that having a mental disorder was associated with an increased likelihood of all-cause mortality (Odds Ratio (OR) 1.4; 95% Confidence Interval (CI) 1.2-1.5. For patients diagnosed with mental disorders the estimated rate of ED visits per year was 2.25 times higher and estimated rate of hospitalization per year 1.67 times higher than for patients with no mental disorders. However, there was no association between having a diagnosis of a mental disorder and one-year treatment retention in OAT adjusted Hazard Ratio (HR) = 1.0; 95%CI 0.9 to 1.1).Conclusion: Our findings highlight the consequences of the high prevalence of mental disorders for individuals with opioid use disorder in Ontario, Canada

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