A recent report from the Legal Action Center and the Bloomberg American Health Initiative found that despite widespread consensus on the importance of addiction treatment in the ER and an unprecedented rise in overdose deaths, many hospitals fail to screen for substance use, offer medications to treat opioid use disorder or connect patients to follow-up care.
Many patients who don’t receive those services die shortly after discharge or within a year of their ER visit, the report says.
But a growing number of emergency rooms and health professionals are trying to change that by developing new approaches that address the missed treatment opportunity in ERs.
Three states – North Carolina, California and New York – are among several that are trying new approaches to addiction treatment.
Dr. Blake Fagan is chief education officer at the Mountain Area Health Education Center in Asheville, N.C. For years, when he approached hospital ERs to offer addiction training, he heard a common refrain.
“We don’t have any place to send patients afterwards,” he says doctors told him.
Without a clear place for patients to continue treatment, the doctors were reluctant to even start medications for opioid use. That’s when Fagan and his colleagues realized their training had to extend beyond hospitals.
They reached out to federally qualified health centers, which treat people regardless of insurance status. In a state without Medicaid expansion and with large rural expanses, these centers serve many people with addiction.
Using just over $1 million in grant funding from two foundations, the Mountain Area Health Education Center has trained the staff at 11 health centers and two local health departments over the past year and a half to provide medications for opioid use disorder. From March 2020 to May 2021, those centers treated more than 400 patients with the disorder.
Dr. Shuchin Shukla, who heads the program alongside partners at the University of North Carolina- Chapel Hill, says the centers have become obvious referral spots for doctors who start patients on medication in the ER.
“We consider ourselves a model for how to do this in a Medicaid non-expansion state,” Shukla says.
North Carolina also has programs to train medical students, residents, nurse practitioners and physician assistants in addiction care.
Dr. Sara McEwen, executive director of the nonprofit Governor’s Institute, which has helped to incorporate the training into medical school curricula, said students who see addiction prevention and treatment as a routine part of medicine will naturally apply that when they reach the ER or other clinical settings.