Wisconsin Continues to Use MAT in ERs to Help Addicts
Wisconsin doctors, substance abuse counselors, and agencies are considering anti-addiction drugs as a first response in emergency rooms across the state and most medical staff in the state’s ERs want to expand medication-assisted treatment (or MAT), according to Wisconsin’s chapter of American College of Emergency Physicians.
“It weighs on you, driving home after a night shift and someone didn’t make it, knowing society could have intervened and helped,” said Bobby Redwood, an emergency and preventive medicine physician.
MAT has been proven effective for successfully treating substance abuse disorders by combining anti-craving medicines such as buprenorphine or methadone with supportive substance abuse counseling and behavioral therapy. Anti-addiction drugs can diminish withdrawal symptoms for a patient in detox. In some cases, weaning patients off their drug of choice with these drugs is actually life-saving.
“A lot of the work we’re doing is figuring out: What does a community need to become buprenorphine ready and medication-assisted treatment ready?” said Redwood.
Wisconsin saw a 35 percent increase in fatal opioid overdoses in the one-year span between 2015 and 2016. Emergency room visits for overdoses were the highest in the nation with a 109 percent increase between 2016 and 2017, according to the Centers for Disease Control and Prevention (CDC).
“For those vulnerable and in underserved areas, the ER is often the only access to health care,” said Gail D’Onofrio, a professor of emergency medicine at Yale School of Medicine. Her team was offered a grant last year totally almost $820,000 to develop a way for ERs to administer buprenorphine despite “bureaucratic and medical barriers to implementation.”
In a landmark study in 2015, D’Onofrio found patients who started on buprenorphine out of the emergency room were twice as likely to stick with treatment compared to those who received only references to clinics. This means they are also twice as likely to avoid an overdose. Wisconsin also has a significant shortage of substance abuse disorder counselors, according to the research association, Pew Charitable Trusts.
In 2017, Governor Scott Walker signed legislation allowing physician assistants and nurse practitioners to prescribe buprenorphine if they completed additional training under supervision.
Now physician assistants and nurse practitioners have an opportunity to identify people with substance abuse disorders who come into their primary care offices or ERs, according to Sam Spencer, a PA working in addiction medicine. “There’s a lot of little towns and physician assistants in the ER who understand addiction and want to do the best for their patients, which is starting them on suboxone,” Spencer said.
“It’s different than prescribing for pain,” said Toni Simonson, executive director of HSHS Western Wisconsin and Prevea Behavioral Care. “It’s prescribing for addiction.”
It’s important to note that buprenorphine is not as effective at treating addiction if a patient can’t follow up with a behavioral health counselor and there is currently no cohesive statewide plan in Wisconsin for implementing MAT. However, the CDC indicates emergency room “data provide an early warning system for health departments to identify increases in opioid overdoses more quickly and coordinate response efforts.”
“I think a lot of our workforce feels hamstrung because they don’t have those behavioral health and primary care follow up resources,” said Redwood, the emergency and preventive medicine physician. “Not because they’re not motivated, but because it doesn’t exist in their county.”