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The MATTERS research team was recently published in the Journal of Substance Use and Addiction Treatment (JSAT)! This article compares retention in treatment for opioid use disorder between individuals who were referred out of the emergency department versus telemedicine settings. Read an excerpt from the publication below, or click here to access the full article online.

Comparison of 30-day retention in treatment among patients referred to opioid use disorder treatment from emergency department and telemedicine settings

By: Joshua J. Lynch, Emily R. Payne, Renoj Varughese, Hilary Kirk, Daniel J. Kruger & Brian Clemency

Introduction

Medications for opioid use disorder (MOUD), such as buprenorphine are lifesaving, evidence-based, outpatient treatments for opioid use disorder (OUD). An emergency department (ED) visit potentiates an opportunity to initiate MOUD for patients in crisis from OUD (Sharfstein, 2017). National guidelines support MOUD initiation in the ED (SAMHSA, 2021) and the literature describes multiple programs for ED-initiated buprenorphine (Bogan et al., 2020; D’Onofrio et al., 2017; Herring et al., 2019; Kaczorowski et al., 2020; Klein et al., 2019; Srivastava et al., 2019; Thomas et al., 2022).

 

The Medication for Addiction Treatment and Electronic Referrals (MATTERS) Network is one such program that facilitates ED-initiated buprenorphine treatment through a system of linked hospital and community prescribers (Clemency et al., 2022). MATTERS supports ED clinicians in their efforts to provide buprenorphine and timely referrals to an affiliated community of buprenorphine service providers in their area. MATTERS has expanded to include referrals from other, less traditional care environments, including correctional facilities, community outreach teams, homeless outreach teams, emergency medical, police, fire services, and telemedicine evaluations.

 

Emergency telemedicine offers a way to deliver urgent medical care remotely using video conferencing or phone consultations (Sikka et al., 2019). This differs from traditional emergency departments by providing immediate access to a healthcare professional without a physical visit. In the context of opioid use disorder, emergency telemedicine consultations can act as a bridge clinic (Taylor et al., 2023). Here, patients can connect with an emergency medicine trained provider who can assess their situation, screen for life threatening emergencies that warrant an in-person evaluation, prescribe treatment to manage withdrawal symptoms and cravings, and then refer them to long-term addiction treatment programs for ongoing support.

 

In recent years, telemedicine has emerged as a feasible alternative to in-person evaluations and interventions for both episodic and long-term care (Allen et al., 2020; Benz et al., 2021; Mahmoud & Vogt, 2019). The challenges of the COVID-19 pandemic necessitated the rapid growth in telemedicine throughout health care, including for treatment of patients with substance use disorder (SUD) (Perrin et al., 2020). Telemedicine was bolstered in 2020, when the Secretary of Health and Human Services waived the requirement for clinicians to perform an in-person evaluation prior to prescribing buprenorphine (Knopf, 2020). To date, much of the telemedicine MOUD literature has focused on ongoing OUD treatment. Less is known regarding the outcomes of patients following telemedicine referrals for MOUD from emergency settings.

 

In mid-2020, the MATTERS Network partnered with the University at Buffalo Department of Emergency Medicine Telemedicine division to provide emergency telemedicine assessments to those seeking care for OUD. The MATTERS emergency telemedicine care team of physicians, nurse practitioners, and physician assistants, who are board certified in emergency medicine, prioritize access to buprenorphine through a telemedicine protocol. The MATTERS team delivers focused, non-stigmatized care to patients in the comfort of their own home or other environments while minimizing gaps in medication. MATTERS emergency telemedicine can be accessed directly by individuals seeking help via a 24-hour hotline in parts of New York State and through the MATTERS mobile application or website (mattersnetwork.org) for other portions of New York State. The hotline is advertised on social media and traditional media (e.g., billboards). Referral sites may also initiate an emergency telemedicine evaluation on the individual’s behalf.

 

Initial stabilization is critical but not sufficient for patients in crisis from OUD. An infrastructure which facilitates follow up and continued engagement is key for long term recovery. The goal of this study was to describe rates of initial outpatient clinic appointment attendance and 30-day retention in care among patients referred through the MATTERS Network by telemedicine in comparison to ED referrals.

Methods

This was a retrospective review of data for patients referred from EDs or telemedicine through the MATTERS Network. All data were initially obtained for clinical or quality improvement purposes…