Thank you to the University at Buffalo Jacob’s School of Medicine and Biomedical Sciences for your support of the MATTERS Network and inclusion of our program in your Fall 2022 Magazine! We are proud to serve as a model program for organizations nationwide.
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Less than a decade ago, the standard of care for treating patients with opioid use disorder in emergency departments was, for the most part, ineffective. Those experiencing withdrawal were typically given non-narcotic drugs, which did little to assuage their symptoms, and, at discharge, were handed a list of phone numbers for treatment clinics. Sometimes patients later discovered that the phone numbers were incorrect.
Allison Brashear, MD, MBA, left, Vice President for Health Sciences at UB and Dean of the Jacobs School of Medicine and Biomedical Sciences, listens as U.S. Department of Health and Human Services Region 2 Director Dara Kass, MD, speaks at the roundtable with Buffalo MATTERS leadership and community health partners. Photo by Sandra Kicman. Retrieved from the University at Buffalo
“Emergency departments are the safety net for the medical system, so they are a critical point of entry for these patients,” says Joshua J. Lynch, DO, clinical associate professor of emergency medicine in the Jacobs School of Medicine and Biomedical Sciences and a physician with UBMD Emergency Medicine. “When patients come to us in withdrawal, we need to be able to help control their symptoms and quickly transition them to community clinics. We knew we weren’t doing a great job with either step, but there weren’t many good alternatives out there.”
That concern motivated Lynch to seek a solution. In 2015, he and his colleagues read a paper by physicians at Yale University that proved pivotal to their efforts.
It reported that patients going through withdrawal who were given the opioid treatment buprenorphine in the emergency department and provided with a clinic appointment were more likely to have reduced their opioid use and remained in treatment a month later.
“When we saw that, we wanted to do it here,” Lynch recalls.
It wasn’t simple. The first step required emergency medicine providers to undergo training mandated by New York State for anyone administering buprenorphine, a controlled substance. After encouraging fellow providers to complete the training, Lynch and his colleagues developed a standardized approach for evaluating and managing patients.
A member of the Erie County Opioid Task Force, Lynch then approached regional clinic directors to see if they would agree to see a few patients each week who had started buprenorphine in the emergency department at Kaleida Health’s Buffalo General Medical Center or Millard Fillmore Suburban Hospital, teaching affiliates of the Jacobs School.
“I was doing this on a case-by-case basis,” says Lynch, who explains that he was making the phone calls himself to the clinic directors.
Soon, it became clear that a more systematic approach was needed.
A Model Program is Born
“It wasn’t sustainable,” says Brian Clemency, DO, professor of emergency medicine at the Jacobs School, who began partnering with Lynch at that time. “We needed a framework.”
That framework developed into what today is MATTERS (Medication for Addiction Treatment and Electronic Referrals), an innovative, cost-effective program that provides medication assisted treatment to opioid use disorder patients and rapidly transitions them into long-term treatment at a community clinic, all within about 48 hours.
The program, initially named Buffalo MATTERS, eventually grew to encompass the eight counties of Western New York. During this transitional time, it received critical seed funding from local foundations, starting with a pilot project grant from the John R. Oishei Foundation in 2017. The following year, Blue Fund of BlueCross BlueShield of Western New York awarded the program a $200,000 grant that supported efforts to train emergency department providers and to recruit community clinics to treat patients discharged from the departments.
In 2019, Lynch received additional funding to expand the project statewide. This was accomplished primarily through the development of an online referral platform housed on a secure communications system that the Department of Health (DOH) operates, with Lynch serving as technical advisor.
The online system streamlines referrals to community based, medication-assisted treatment (MAT) providers and allows them to provide ongoing care for those started on MAT in the emergency department. It also supports access to resources for providers and captures valuable outcomes data to evaluate the effectiveness of the program.
Lynch and his colleagues also developed an app for Apple and Android devices that emergency medicine providers throughout the state can use to link patients to resources and long-term care, regardless of the patients’ health history or insurance status. Their work on the app was supported by funding from the UB Clinical and Research Institute on Addictions.
Designed to remove as many barriers to care as possible, MATTERS also provides round-trip transportation vouchers for the first clinic visit and offers a medication voucher program to cover the cost of a buprenorphine prescription for up to 14 days. The vouchers are redeemable at more than 1,000 public and privately owned pharmacies statewide, including CVS, Walgreens and Wegmans.
MATTERS now partners with over 160 community-based clinics, 1,000 pharmacy locations statewide and nearly 100 hospitals. It also offers an average of 1,700 appointment slots each week to patients seeking treatment for opioid use disorder.
Last fall, the New York State Department of Health provided funding to hire an additional nine regional care coordinators for MATTERS.
The coordinators are working to facilitate the expansion of the program beyond hospitals to nontraditional care settings—including law enforcement agencies, correctional facilities and pre-hospital settings—in specific regions in the state.
Interest at the Federal Level
The program’s success has not gone unnoticed. This spring, U.S. Department of Health and Human Services (HHS) Region 2 Director Dara Kass, MD, visited the Jacobs School to meet with Lynch and his colleagues, as well as Jacobs School administrators.
Kass—an emergency medicine physician by training whom President Joe Biden appointed as HHS Region 2 director in November 2021—oversees HHS operations in New York, New Jersey, Puerto Rico and the U.S. Virgin Islands. She was in Buffalo for a few days to convene stakeholder meetings with partners aligned with HHS health priorities, which include treatment for opioid use disorders.
Kass was impressed by the level of integrated care MATTERS provides patients and said that President Biden fully endorses such efforts. “This administration is committed to supporting programs that get medication into the hands of patients who need it,” Kass said.
“I am grateful to be here with you. I am grateful to everyone working together and providing an incubator and a pilot for what I hope to help communicate to the rest of the country,” she added.
Allison Brashear, MD, MBA, vice president for health sciences at UB and dean of the Jacobs School, who attended the meeting, praised the work Lynch and his colleagues have done in expanding MATTERS across New York State. “We are so proud of what has been created here,” she said, adding that UB’s breadth of health sciences schools and their associated educational and research opportunities uniquely position UB among other schools nationally, especially when it comes to treating conditions such as opioid use disorder.
“We are committed to training the next generation of physicians to be patient-centered,” Brashear said. “This means understanding what patients and families need in terms of comprehensive teambased care—and MATTERS is a great example of this.”
The roundtable discussion included several Jacobs School faculty members affiliated with MATTERS, as well as key community health partners, such as Evergreen Health Services, Horizon Health Services and BestSelf Behavioral Health. Additional partners present included Cheektowaga Police Chief Brian Gould and representatives from Albany Medical Center’s Department of Emergency Medicine.
Also in attendance were representatives from three New Jersey organizations with which MATTERS is forging a partnership as the program continues its expansion: Cooper Health, the New Jersey Department of Human Services and the New Jersey Department of Health.
Lynch and his colleagues are also working to make the program available to people who are incarcerated, and through obstetrics and gynecology offices to treat pregnant women who are opioid users. They have been contacted by cities throughout New York State and beyond that are interested in starting programs similar to MATTERS and have presented on the subject to international audiences.
At the roundtable with HHS, Clemency described how UB physicians created a standardized dose of buprenorphine that emergency room doctors can administer to patients who are in withdrawal. If patients aren’t experiencing withdrawal, then they are given instructions on how to administer buprenorphine at home once they begin having severe withdrawal symptoms.
Before being discharged from the emergency departments, patients are provided an iPad that shows them the options they have for a community clinic to attend.
“One of the most unbelievably empowering things for a patient who’s used to being told what to do, is handing them an iPad and saying, ‘Here are all the places that you can go tomorrow to be seen; you tell us where you want to go,’” Clemency said.
Telemedicine Introduced
In 2020, COVID-19 presented yet another barrier to treatment for patients with opioid use disorder, as emergency departments were swamped with people severely ill with the virus.
In another demonstration of its commitment to removing barriers to care, MATTERS developed virtual emergency departments staffed by UBMD emergency medicine physicians in Kaleida Health hospitals and at Erie County Medical Center.
Buffalo MATTERS founder and medical director Joshua Lynch, MD, clinical associate professor of emergency medicine and a physician with UBMD Emergency Medicine speaking to the roundtable. Photo by Sandra Kicman.