The University of Alabama at Birmingham (UAB) proposes to implement the “Initiating Medication Assisted Treatment of Opioid Addiction in the Emergency Department: The ED MAT Protocol.” The overarching purpose of the ED MAT protocol is to increase the number of individuals with opioid use disorder (OUD) receiving MAT services in Jefferson County, Alabama by initiating MAT in patients with OUD in the Emergency Department (ED) and activating bedside MAT referral services.
The population of focus for this project will include patients presenting to two EDs seeking treatment for OUD, including pregnant females, US service veterans, and individuals recently released from correctional facilities. Emergency Departments are the tip of the spear where societal problems meet healthcare, and Alabama leads the nation with the highest rate of opioid prescriptions in the country. Project goals that will be met during the 3-year project period are to: 1) Obtain Data 2000 waiver training in at least 75% of UAB ED clinicians, 2) Implement an evidence-based protocol in the UAB electronic medical record, 3) Treat and refer 550 individuals with OUD for MAT, 4) Increase treatment completion rates by 5-10% each year, 5) Have 75% of MAT clients report abstinence from opioids at 6-months, and 6) Decrease opioid overdose deaths in Jefferson County by 30% over 3 years.
Jefferson County is the most populous county in the State of Alabama, 43% of which are African American, 54% Caucasian and 18% who live below the federal poverty level. We will identify 150 patients seeking care for non-fatal opioid overdose, opioid withdrawal, or detoxification in year 1, 200 in year 2, and 200 in year 3 (550 total). While the patient is in the ED, the diagnosis of OUD will be confirmed, the presence and severity of withdrawal assessed using the Clinical Opioid Withdrawal Scale, buprenorphine/naloxone induction initiated as appropriate, a short prescription for buprenorphine/naloxone and take-home naloxone kit provided, and the patient will be connected face-to-face with a peer navigator at the point of crisis.
The ED MAT protocol is a collaborative effort between Ryan White HIV/Hepatitis C screening program leadership at the UAB Center for AIDS Research and UAB 1917 Clinic, the Recovery Resource Center and Opioid Treatment Clinic at Cooper Green Mercy Health Services, the UAB Center for Psychiatric Medicine and Addiction Recovery Program, the Birmingham Fellowship House, and the UAB Beacon Addiction Treatment Center.