Innovative Pharmacological Approaches to Treating Alcohol and Opioid Use Disorders in the Emergency Department

Patients with substance use account for 1 in 11 ED visits. Evidence based therapies to treat opioid (OUD) and alcohol use disorders (AUD) are underutilized and cost effective. Substance use treatment initiated in the ED is increasingly recognized as a unique touchpoint for patient access and should be amplified to support this vulnerable patient population to disrupt and mitigate the substance use cycle. Innovations in formulations and approach to OUD and AUD medications for patients who can be safely transitioned to community partners are evolving. All presenters have extensive clinical trial experience in the initiation of novel 7-day injectable buprenorphine formulations in ~800 ED patients. Additionally, all have experience using screening and early patient engagement to identify candidates for initiation of treatment for AUD utilizing oral and injectable medications and optimizing care transitions to follow up.

Innovative solutions to the process of developing and implementing specific ED pathways that can be optimized to each setting and care transition will be described. Process mapping, contextual inquiry with ED based focused groups can highlight a consensus approach to effective substance use screening and treatment when stakeholders have discussed barriers and facilitators to implementation. Optimizing ED flow and developing partnerships with local pharmacies, opioid treatment programs and community health centers to enhance care transitions will be discussed. Emergency physicians will develop a depth of understanding to utilize tools for early treatment and enhanced care transitions to mitigate the escalating substance use crises, and improve outcomes, including treatment retention and reduced hospitalizations.

Presenters:

  • Andrew Herring, MD
  • Kathryn Hawk, MD, MHS
  • Jeanmarie Perrone, MD
  • Gail D'Onofrio, MD, MS
Authors

  • Andrew Herring, MD

    Alameda Health System–Highland Hospital

    Dr. Andrew A Herring graduated from Harvard Medical School and completed his residency in emergency medicine at Highland Hospital—Alameda Health System (AHS) in Oakland, CA where he is an emergency physician and Chief of Addiction Medicine including emergency, inpatient, outptient clinic, and telehealth services. Dr Herring has led national efforts to transform hospital-based care for substance use disorders and his work has been featured in local and national press including the New York Times, Los Angeles Times and National Public Radio. Dr. Herring co-founded and is a PI at CA BRIDGE, one of largest state level efforts to promote access to medication for opioid use disorder in the hospital settings. Dr. Herring’s research has been funded by the National Institutes of Health (NIH) and the Patient-Centered Outcomes Research Institute (PCORI) and has been published in numerous journals including JAMA Open and Annals of Emergency Medicine; his work focuses on treatment of substance use disorders and pain management. He is a co-investigator NIDA CTN 0099 (ED-INNOVATION), and principal investigator for the Public Health Institute CA Bridge Outcomes Study. He has conducted health policy research as a Fulbright Scholar in Central America. Dr. Herring is board-certified in Emergency Medicine, Addiction Medicine, and Pain Medicine, and is Associate Clinical Professor of Emergency Medicine, at UCSF.

  • Kathryn Hawk, MD, MHS

    Yale University

    Kathryn Hawk, MD, MHS is an Associate Professor in the Yale Department of Emergency Medicine, the Program in Addiction Medicine, and the Yale School of Public Health. She was a NIDA K12 Drug use, Addiction and HIV Research (DAHRS) Scholar. Her research focuses on the design, testing and implementation of evidence-based care for ED patients with substance use disorders, with a focus on initiating treatment for alcohol and opioid use disorder in the ED and linking patients to ongoing treatment using innovative strategies.

  • Jeanmarie Perrone, MD

    University of Pennsylvania

    Jeanmarie Perrone, MD is a Professor in the Department of Emergency Medicine and the founding Director of the Penn Center for Addiction Medicine and Policy at the University of Pennsylvania. Dr. Perrone leads a program for the treatment of Opioid Use Disorder in the emergency department (ED) and a virtual telehealth bridge clinic (CareConnect) for low barrier access to medications for opioid use disorder. She has advocated at the state and national level for enhancing equitable care for substance use. She has attended numerous FDA meetings while serving on the Drug Safety and Risk Management Advisory Committee and is a lead Co-Investigator on a NIDA CTN multi-site study of ED initiated buprenorphine. She has won numerous awards for education and mentorship and is board certified in emergency medicine, medical toxicology and addiction medicine.

  • Gail D'Onofrio, MD, MS

    Albert E. Kent Professor of Emergency Medicine

    Yale University

    Gail D’Onofrio, MD, MS is the Albert E. Kent Professor of Emergency Medicine and Professor of Medicine and Public Health at Yale University Schools of Medicine and Public Health. She has extensive experience as a leader, researcher, mentor, and educator, internationally known for her work in substance use disorders. As a physician-scientist she has had continual NIH-funding for over two decades, designing and conducting clinical trials that have changed clinical practice. In addition, she was one of the founding members of the Board of Addiction Medicine, that became recognized as a ABMS approved subspecialty in 2016, sponsored by the American Board of Preventive Medicine. Dr. D’Onofrio is the MPI of the New England Consortium Node for the NIDA Clinical Trials Network and is the MPI of both a NIDA-funded and NINDS funded K12 training program. She is committed to preparing young faculty to become independent investigators advancing the science of Emergency and Addiction Medicine. 

Related Media