The University of Alabama at Birmingham (UAB) Emergency Medicine Department (ED) proposes to complete the public health service project - Expanding Emergency Department-initiated Medication and Treatment Referral for Opioid Use Disorder (MOUD) in Alabama. Alabama has led the nation with the highest rate of opioid prescriptions in the country since 2014, and overdose deaths in the Jefferson County catchment area increased to to an all-time high of 36.8% in 2020. The overall purpose of the proposed project is to enhance access to Medication Assisted Treatment (MAT) services for persons with an opioid use disorder (OUD) by expanding ED-initiated MOUD program services to additional areas in North Central Alabama heavily impacted by the opioid crisis.
The specific target population includes OUD cases presenting to three UAB-EDs: the "main" UAB Hospital ED (UED), the "satellite UAB Highlands Hospital ED (HED) and the community-based Gardendale "Freestanding" ED (GED). The broader UAB-ED population of focus includes representation from racially diverse patient groups (49% Black, 44% White, 7% Other), underinsured or uninsured groups (42%), pregnant females, US service veterans and previously incarcerated individuals.
Goals of the 5-year project are to (1) Maintain 75% of UED and HED providers with DATA 2000 waiver training, obtain DATA 2000 waiver training by 75% of GED providers in year-one, obtain DATA 2000 waiver training by 25% of Nurse Practitioners/ Physicians Assistants at each UAB-ED site in year-one; (2) Treat and enroll 480 total OUD cases in the UAB ED-initiated MOUD program (60 in year-one + 120 in years two, three and four + 60 in year-five); (3) Improve retention in care for program participants by increasing MAT treatment completion by 5% each year; and (4) Decrease rates of prescription and illicit opioid drug use and overdose deaths in Jefferson County by 30% over five years.
While the patient is still in the ED, providers will confirm the diagnosis of OUD, assess presence and severity of withdrawal using the Clinical Opioid Withdrawal Scale (COWS), and initiate buprenorphine/ naloxone induction as appropriate. Project staff will work with ED providers to facilitate access to a temporary "bridge" prescription for buprenorphine/ naloxone at no cost to the participant, and establish a face-to-face (or virtual) connection to certified Peer Recovery Specialist prior to discharge. With the support of existing network MAT assessment and referral partners, project staff will provide follow-up services to ensure ED-OUD participants are successfully linked to outpatient or residential treatment services, including comprehensive MAT services.
The UAB ED-initiated MOUD program is a collaborative effort between the Ryan White HIV/ Hepatitis C screening program leadership at the UAB 1917 Clinic and UAB Center for AIDS Research, the UAB Beacon Addiction Recovery Center, the Birmingham Fellowship House and the Cahaba Medical Center.