Can Addiction Medication Help Emergency Room Patients Who Abuse Opioids Reduce Their Use? New Study Findings Suggest It Can
The opioid crisis in the U.S. is on the rise, with deaths from prescription opioids quadrupling since 1999. In 2013, more than 16,000 people died from prescription opioid overdoses in the U.S., and almost 2 million misused or were dependent on opioids. Roughly 700,000 emergency room visits related to opioid misuse occurred in 2011.
People who end up in the emergency room and are found to use opioids should receive an assessment and, if necessary, an intervention. A promising approach that can be implemented in emergency rooms, primary care and pediatric clinics is called SBIRT, which stands for Screening Brief Intervention & Referral to Treatment. It consists of a conversation between a health care provider and the patient and is designed to screen for substance misuse, motivate the individual to cut down or stop using, and seek treatment if necessary.
For people with less severe problems, this may be sufficient. People with addiction need more than the “Screening Brief Intervention” of SBIRT; unfortunately the “Referral to Treatment” component of SBIRT is often unsuccessful – the likelihood of the person actually accessing treatment or receiving more intensive services after leaving the emergency room or other medical clinic is low.
There are different types of treatment for opioid addiction. One such treatment is an approved medication called buprenorphine, which effectively manages symptoms of the disorder, such as cravings and withdrawal. But can medications like buprenorphine help to enhance the effect of the emergency room SBIRT service and further support the patient’s ongoing treatment?
A recent four-year study conducted by the Yale School of Medicine answered this question. People presenting to the emergency department at Yale-New Haven Hospital who were addicted to opioids and agreed to participate in research were divided into three groups, each of which received a different form of SBIRT support:
- The first group was given a screening for substance use and referral to treatment by being provided with a list of local treatment programs (referral group)
- The second group was given a screening, brief intervention and facilitated referral, in which a health care provider arranged treatment for the patient with an outside agency (brief intervention group)
- The third group was given a screening and brief intervention, and then treatment with buprenorphine while in the emergency room, and was then referred to a primary care physician in a nearby Yale clinic for a 10-week follow-up (buprenorphine group)
The study results were interesting:
- After a 30-day follow-up, 78 percent of patients in the buprenorphine group were receiving treatment; this was a significantly higher rate than patients in the brief intervention group (45 percent) and the referral group (37 percent)
- All three groups experienced a reduction in opioid use over time, but patients in the buprenorphine group reported the greatest reduction of days of opioid use per week
- Patients in the referral and brief intervention groups used inpatient addiction treatment services at higher rates than those in the buprenorphine group, indicating that they needed higher levels of addiction care than those who received the medication
The Yale study relates to ongoing work being done at CASAColumbia. As part of a federal grant from the Substance Abuse and Mental Health Services Administration, CASAColumbia has been working with the North Shore-LIJ Health System and the New York State Office of Alcoholism and Substance Abuse Services (OASAS) to provide SBIRT services to people who otherwise would not be identified and connected with necessary services.
To date, more than 100,000 patients have been screened for risky substance use in emergency rooms and primary care practices, and thousands of brief interventions and hundreds of referrals have been provided.
The results of the study at Yale-New Haven Hospital are consistent with some of our experiences with SBIRT at North Shore-LIJ:
- We see the tremendous value of providing SBIRT as a standard level of service in emergency and primary care departments of a hospital. We endorse universal screening and brief intervention when indicated and believe both are feasible to implement through training of medical personnel, careful planning and workflow considerations and close monitoring
- SBIRT may be helpful by itself for people with less severe substance use problems, but should be seen as only the first step in an ongoing treatment process for those with more severe symptoms
- For those with more severe symptoms, a successful referral to an outside treatment agency for ongoing care using medication-assisted treatment may not be as effective as providing the ongoing treatment within the same health system, as was the case in the Yale study, in which buprenorphine was initiated in the emergency room and then continued one block away at the primary care center within the same hospital
More research is needed to determine how community treatment providers and emergency rooms might be able to work together to provide initiation and ongoing care using medications. The delivery of on-site SBIRT for all patients and on-site medication-assisted treatments for opioid addiction should become more routine practices in hospital settings to help address the opioid epidemic and prevent overdose deaths.
CASAColumbia, in partnership with North Shore-LIJ and OASAS, is continually looking for new ways to enhance the referral to treatment process. This study, showing the effectiveness of buprenorphine, provides an innovative method that builds on the SBIRT process and gets more people who struggle with opioid addiction into treatment.
To learn more about the SBIRT project going on at CASAColumbia or to download our “Implementation and Process Change Manual for Practitioners,” click here.
Megan O'Grady, PhD
Megan O'Grady is a Research Scientist and Associate Director of Health Services Research at CASAColubmia
Kristen Pappacena, MA
Kristen Pappacena is a Research Associate at CASAColumbia