Emergency departments see patients who are dealing with opioid use disorder on a daily basis.
The Tennessee Department of Mental Health and Substance Abuse Services and the Tennessee Hospital Association have partnered to bring medication-assisted treatment to emergency rooms statewide. Nashville General Hospital has joined the second cohort of the program, with plans to implement medication-assisted treatment in early 2024.
The city’s safety-net hospital will receive $250,000 to spend on buprenorphine, naloxone, transportation for patients and incentives for doctors to get involved in the program.
Dr. Deann Bullock
From Jan. 1 until Sept. 30, 520 people died from drug overdose in Davidson County.
Dr. Deann Bullock, emergency department medical director at Nashville General Hospital, tells Scene sister publication the Nashville Post that the hospital sees multiple patients with opioid use disorder each day. Some patients come to the department with withdrawal symptoms, some are actively under the influence, and some come for other health problems. She says emergency room providers refer patients to addiction services when they can.
“The few places that we can refer to at times may not have availability, it may be the weekend, it may be the night,” Bullock says. “There's no consistency in it, and it is not something that's required of our providers, nor is it something that is universally implemented across the board.”
As part of the program, emergency room patients will get their first doses of buprenorphine, a drug that is Food and Drug Administration-approved to treat opioid use disorder, in the ER at no cost to them. Then they will be referred to area resources to continue recovery. In the three-year program, the amount distributed decreases gradually each year, with the hope that the hospital can sustain the program in the fourth year and beyond.
Bullock says Nashville General’s goal is to establish a structure for physician training, referral and treatment, but its success is still limited by available area services.
“I think any time you're dealing with some of this population, resources are limited,” she says. “This is providing an opportunity for us to develop what works for us, what works for our community, what works for our patients.”
In the first contract period, three hospitals (Jackson-Madison County General Hospital, Ascension Saint Thomas Rutherford and UT Knoxville Medical Center) administered buprenorphine to 306 patients, 533 patients left the emergency department with naloxone in hand, and 1,755 were referred to recovery navigators.
The medication-assisted treatment program builds off the Tennessee Recovery Navigators initiative, a peer recovery program that TDMHSAS introduced in 2018. Navigators with lived experience help connect patients to available resources and follow up with them in the days and months following an incident.
Jessica Youngblom
Jessica Youngblom, director of strategic initiatives at TDMHSAS, says that in the first cohort she saw strengthened coordination between hospitals and area addiction service providers, and the program helped decrease stigma for those with opioid use disorder and for the use of medication-assisted treatment throughout the emergency department.
“[Participating physicians] said it actually revitalized them to have something they can actually do with patients coming in with opioid use disorder,” Youngblom says. “A lot of times an individual is handed a resource sheet. Most of the time it's outdated. They don't really feel like they're helping, and they felt like this was actually giving them a tool to help individuals who need the service.”
Youngblom says she has fielded concerns that emergency rooms will become nothing more than a medication-assisted treatment clinic. In 2024, hospitals involved in the project will begin tracking whether individuals they serve come back within seven days.
“This program is so much more than just providing a medication,” she says. “It's really being able to treat people at the right time when they're ready, no matter what environment they're showing up in, and then making sure that they're getting connected to this community-based treatment so that they continue their recovery journey. I think something about this project that I want people to hear loud and clear is that it's not just giving medication. It's so much more than that.”
An initial goal for the project was to increase the number of physicians who had completed a federally required training called the X waiver to administer buprenorphine (eight hours of training for doctors and 24 hours for other medical professionals). In December 2022, President Biden signed the Consolidated Appropriations Act, which eliminated additional federal requirements for physicians to prescribe buprenorphine. Physicians are also no longer limited in the number of patients they can provide medication-assisted treatment.
Nashville General is still evaluating what training it will require to get physicians comfortable with administering buprenorphine, Bullock said.
Medication-assisted treatment is also set to be part of the 15-month pilot program chosen by the Nashville-Davidson County steering committee tasked with spending $23 million in opioid abatement funds. At the latest Metro Behavioral Health and Wellness Advisory Council meeting, committee members said the request for proposal for that pilot program is expected to be released in late January or early February.
This article was first published by our sister publication, the Nashville Post.
