Emergency departments are often on the front lines of the opioid crisis in the U.S.: rates of opioid-related visits to the emergency room are on the rise. Yet often, doctors and providers that work in these settings aren’t always fully prepared with the tools they need to connect these patients to treatment pathways and programs.
This month, a group of emergency department providers from across Michigan gathered at the Emergency Department Medication for Opioid Use Disorder Symposium to share their work to expand access to medication for opioid use disorder. The event was presented by the Community Foundation of Southeast Michigan, the Michigan Opioid Partnership and the Michigan Health & Hospital Association MHA Keystone Center.
Dr. William Beecroft, medical director of behavioral health at Blue Cross Blue Shield of Michigan, shared his expertise in how emergency department providers can facilitate the use of medication-assisted treatment for opioid use disorder – and can ultimately connect these patients to a collaborative care pathway to facilitate long-term recovery from their illness. This is important as the goal is to keep patients on medications for opioid use disorder for at least two years in order to see the greatest benefit, Beecroft said.
Medication for opioid use disorder is an evidence-based approach to reducing opioid use and retaining patients in treatment. Medication including methadone, buprenorphine and naltrexone can help patients by reducing cravings, minimizing withdrawal symptoms and preventing overdose – allowing patients to engage more fully in their recovery to reach their goals.
In Michigan, 75 hospitals representing half of Michigan’s emergency departments are participating members in the Emergency Department Medication for Opioid Use Disorder initiative, which began in 2019. The goal of this work was to increase access to evidence-based treatment and transition patients to long-term, office-based programs after being discharged from the ER.
Emergency room providers play a critical role in initiating this treatment pathway for patients: a2015 study found twice as many patients that received medications for opioid use disorder in the emergency room were in a treatment program for opioid use disorder30 days after their visit when compared to patients who did not receive medications for opioid use disorder.
“Being able to assess what’s going on for them, being able to get a system in place that you can be able to discharge them somewhere you know they’re going to be able to get a continuing protocol of treatment,” Beecroft said of the role of emergency department providers for patients with opioid use disorder. “This is expensive work to do in the emergency room.”
Beecroft discussed some of the billing codes hospitals can use to cover the costs of different services that patients with opioid use disorder need to be set up for success to recover from their illness, including peer support and care management.
“Treatment for patients with opioid use disorder is not just drugs: it’s helping them understand their disease, the need for psychosocial treatment and services, and being able to move forward to follow up with the medications. Housing is a big issue as well. Being able to look at enhancing support systems and being able to use case management,” Beecroft said.
Blue Cross Blue Shield of Michigan supports several programs that helps providers keep patients with opioid use disorder in a treatment pathway:
- The Collaborative Care Model can help keep patients engaged in treatment. Mental health care can be delivered in the primary care setting, as behavioral health care managers and a consulting psychiatrist are added to the primary care team. More than 213 practices and 1,100 providers in Michigan are following this model of care. Early results have shown the model, first launched by Blue Cross in 2022, is proving to be successful for providers and patients. Primary care providers feel more comfortable delivering behavioral health care, and patients receive access to timely, effective, less costly and less stigmatized care.
- Adult Intensive Services is for people with chronic illnesses, including severe depression, psychosis and/or suicidal ideation. This program provides patients with whole-person care with wrap-around services, delivered by community partner providers. Face-to-face care management helps to assess and address underlying social determinants of health, and can assist in reducing barriers to care.
- Crisis services can help provide help when it’s needed most. These services, delivered through participating community providers, provide interconnected case management with immediate help in a time of need as well as the next steps needed to stabilize and recover. Psychiatric urgent care, mobile crisis units, crisis stabilization and crisis residential services are available at a growing number of providers across Michigan.
These crisis services can work alongside emergency departments to develop a treatment plan for patients with opioid use disorder, and work to get a patient the right level of care the first time – often in a way that is less stigmatizing, Beecroft said.