Introducing Buprenorphine in the ED – What is Happening in Maine

by: Ranjiv Advani, MD, FACEP and Kayla Cole, CSP-SM

In 2015, Gail D’Onofrio published the first paper describing a program to initiate buprenorphine treatment to Emergency Department patients with Opiate Use Disorder (OUD), using meds in the ED and a warm handoff to a treatment program. The results were quite compelling, but the concept seemed bold at the time, and attempts at initiation of similar programs in other Emergency Departments initially met with quite a bit of resistance. Now, only a few years later, while not quite “mainstream”, these programs are now gaining more widespread acceptance.

We started our program at Mid Coast Hospital in late 2017. Other departments such as at Miles Memorial, Down East Community, Calais Regional and Mercy Hospital were not far behind. Experience across the state has shown that these programs have been quite successful, and have not unleashed a flood of OUD patients into the ED. We have begun to play our part in reversing the trends of the Opioid Epidemic, by intervening when there is motivation to change, mitigating withdrawal symptoms, and directing patients to definitive care efficiently. Moreover, we have shown that simply by having these programs, and giving the providers an effective and streamlined tool to intervene, we can begin to impact the stigma and bias associated with these patients. To date, 12 Maine EDs have begun buprenorphine programs, with 2 additional sites planning on go live this fall.

More recently, we have seen a new commitment to the Opioid Epidemic in Augusta with the Mills Administration. The appointment of Gordon Smith to the position of Opioid “Czar” gives a familiar and trusted face to new programming. Among the Administration’s top initiatives includes the goal of having ED Initiated Buprenorphine Programs in every ED in the state. In 2019, Maine Quality Counts (now Qualidigm) partnered with BlueWater Emergency Partners as well as members of the addiction treatment community and were awarded a State contract to begin Project RISERapid Induction Starting in the ED. The goal of this program is to provide education and support to Maine Emergency Departments as they initiate and implement ED IMAT programs. The team has developed training materials including best practices and protocols and has conducted in-person trainings for 5 Departments, with 3 more planned in the near future. We have hosted 3 Webinars and 3 ECHO sessions, with one more ECHO session planned for August 28. The team continues to be available to provide workflow and technical assistance to any ED with either and existing or new program. We are currently in the process of recording training modules and developing an online toolkit.

MAT Panel at the Maine Opioid Summit: Turning the Tide held in Augusta in July. Lisa Letourneau, MD; Alane O’Connor, DNP; Donna Lawler, APRN-ANP; Ranjiv Advani, MD.

The Emergency Department is particularly well suited to intervene effectively in this current epidemic, in a way that can quickly and efficiently get patients to definitive care, that can change your patients’ perception of the health care community, and that can change our providers’ engagement with this patient population. If you have not yet done so, I ask you to consider implementing a program at your site.

Questions regarding the RISE program, and to help troubleshoot your programs as you launch and begin down this road can be directed to Kayla Cole or to Ranjiv Advani.