MATTERS goes statewide

Powerful opioid treatment program developed at UB goes statewide

buffalo.edu
Ellen Goldbaum
July 24, 2019

BUFFALO, N.Y. — A program developed by University at Buffalo emergency medicine physicians to expedite patient access to comprehensive and effective opioid use disorder treatment is going statewide.

Right now, Buffalo MATTERS is available through the emergency departments of 17 hospitals, including all Kaleida Health, Catholic Health, and Erie County Medical Center facilities, throughout the eight counties of Western New York. This was made possible by last year’s $200,000 award from the Blue Fund of BlueCross BlueShield of Western New York. A pilot project grant from the John R. Oishei Foundation provided initial funding in 2017.

Buffalo MATTERS provides medication-assisted treatment to opioid use disorder patients in emergency departments and rapidly transitions them into long-term treatment at a community clinic of their own choosing, all within about 24-48 hours.

Approximately 150 patients have been referred from local emergency departments through Buffalo MATTERS. The program is believed to be one of several factors contributing to the decline in opioid-related deaths in Erie County, with 186 deaths confirmed in 2018, compared to 251 in 2017 and 301 in 2016.

Expanding across the state

Support from the New York State Department of Health (NYSDOH) will allow the program to expand across New York State and increase the utilization of buprenorphine in the emergency department. In the next 6-12 months, it is anticipated that the MATTERS concept will be implemented in hospitals in the greater Albany and mid-Hudson regions along with hospitals and clinics in the New York City area.

The program’s founder, Joshua Lynch, DO, (@JLynchDO) clinical assistant professor of emergency medicine in the Jacobs School of Medicine and Biomedical Sciences and a physician with UBMD Emergency Medicine, will serve in this effort as a technical advisor to the NYSDOH.

According to the NYSDOH, settings such as emergency departments are on the frontline of the opioid crisis and can serve as a crucial point of engagement for people with opioid use disorder. NYSDOH has recognized this and has made significant efforts to support the continued integration of buprenorphine in emergency departments across New York State.

Additional support from the NYSDOH has led to new developments within the MATTERS program, including an online electronic referral system that will be housed on a secure communications system operated by the department. The online referral system will streamline referrals to community-based, medication-assisted treatment (MAT) providers and allow them to provide ongoing care for those initiated on MAT in the emergency department setting. This online system will support access to resources for providers and provide an opportunity to capture robust outcomes data to evaluate the effectiveness of this program.

‘Changing—and saving—lives’

“Through the emergency departments of Western New York hospitals, Buffalo MATTERS has been changing — and saving — the lives of patients suffering from opioid use disorder,” said Nancy Nielsen, MD, PhD, senior associate dean for health policy in the Jacobs School of Medicine and Biomedical Sciences at UB and a member of the Erie County Opiate Epidemic Task Force.

“These patients arrive at our emergency departments, many in desperate circumstances, often as a last resort. This funding from the New York State Department of Health will bring the successes that we are starting to see in Western New York to all of the regions of our state and, we hope, beyond.”

The program began in 2015, as UB physicians were trying to find a better way to treat patients who came to local emergency departments in withdrawal.

“We needed to be able to help control their symptoms and quickly transition them to community clinics,” recalled Lynch. “We knew we weren’t doing a great job on either one, but there weren’t many good alternatives out there.”

Joshua Lynch, DO, explained how he developed and implemented Buffalo MATTERS with the cooperation of numerous community partners. (Credit: Douglas Levere, University at Buffalo)

Yale University research

Lynch and his colleagues began studying methods implemented by physicians at Yale University, who found that patients going through withdrawal who were given the opioid treatment buprenorphine in the emergency department and then provided with a clinic appointment were more likely to still be in treatment a month later and to have reduced their opioid use.

“When we saw that, we wanted to do it here,” Lynch said. He began to encourage colleagues to undergo the training providers need to administer buprenorphine, a controlled substance. After providers got the training, Lynch and his colleagues developed a standardized approach for evaluating and managing patients.

A member of the Erie County Opiate Epidemic Task Force, Lynch then began approaching clinic directors to see if they would agree to see a few patients each week who had started buprenorphine in the emergency department either at Buffalo General Medical Center or Millard Fillmore Suburban. Both are teaching hospital partners of the Jacobs School and part of Kaleida Health.

Currently, 47 Western New York clinics provide more than 120 appointment slots each week exclusively to treat opioid use disorder patients, usually within 24-48 hours of being discharged.

And patients are responding. “The patient in withdrawal who drives to the emergency room because they know they need help is looking for a way to get better,” said Lynch.