Bringing emergency physicians on board with the idea of initiating patients on medication-assisted treatment (MAT) for opioid use disorders can present challenges, acknowledges Frank Edwards, MD, FACEP, emergency medicine residency director at Arnot Ogden Medical Center (AOMC) in Elmira, NY.
“The perceptions that a lot of physicians have is that these are patients they don’t want to deal with,” he says.
However, Edwards stresses physicians must understand they are going to encounter these patients one way or the other. “These are patients who would otherwise be coming in to hit you up for a prescription for Percocet for their back pain ... or they would be coming in with abscesses from shooting up,” Edwards shares. “We have a problem, and the medical profession is partly responsible, so we should step up to the plate and help.”
Edwards has found this message resonates, at least with most emergency physicians in his own ED. Residents in particular enthusiastically support AOMC’s policy of providing buprenorphine to patients who present with opioid withdrawal symptoms and referring them a local treatment center for continued care.
While one of seven attending physicians in the ED expressed some skepticism of the idea that providing treatment for patients in withdrawal should be part of an emergency physician’s scope of practice, most were at least open to the idea once they learned more about buprenorphine, Edwards recalls.
“It is a very safe medicine, and many physicians are frankly scared of buprenorphine or Suboxone,” Edwards observes. “It is the lack of familiarity and the fact that the DEA has it in a special category right now.”
Ann Domingos, LCSW-R, CASAC, CADC, the CEO of CASA-Trinity, agrees that a lack of familiarity with buprenorphine often is behind emergency provider resistance to taking on patients with opioid addictions. “Without a lot of experience in the field ... they get concerned about providing this medication,” she says.
Educating providers about buprenorphine or Suboxone can remedy this problem, but this often requires ongoing persistence, Domingos observes. “The challenge is that doctors rotate so often that sometimes the information doesn’t get to them,” she adds.
Fortunately, Domingos sees more emergency physicians coming around to the idea that they can play a role in the treatment of opioid addiction, and they are more open to new approaches in the ED. “There has been a lot of work [in this area] over the past four years,” she notes. “It really makes it impossible for people to bury their heads in the sand.”