Calif. ED to Start Medication-Assisted Treatment Program

The Marin Independent Journal, Novato, Calif.

MarinHealth Medical Center has received a $126,000 government grant to start a medication assisted treatment program for opioid addiction in its emergency department.

Dr. Dylan Carney, the MarinHealth emergency physician overseeing the program, said one of the main objectives is to change the way practitioners in the emergency department think about addiction.

“There is so much stigma around general substance use disorder and opioid use disorder,” Carney said. “The more we talk about it and normalize it like any other medical condition, the more we’ll be able to truly address it.”

According to public health officials, there were 165 opioid overdoses in Marin County through October, and so far this year 11 Marin residents have died of drug overdoses. Last year, there were 30 drug overdose deaths in Marin.

In the past, the medical center, formerly known as Marin General Hospital, would treat overdose patients’ symptoms, get them stabilized and discharge them with a phone number or address for an outpatient drug treatment clinic.

But Carney said a 2015 clinical trial demonstrated that starting patients on buprenorphine in the emergency department and assisting them in linking up with an outpatient treatment program before withdrawal symptoms develop doubles the likelihood of them remaining in a 30-day treatment program.

Buprenorphine, a partial opioid agonist, provides relief of withdrawal symptoms for up to 24 hours without significant euphoria, sleepiness or respiratory depression.

Once a patient is on buprenorphine, emergency room doctors need to get them to a treatment clinic that can continue to prescribe buprenorphine for them before withdrawal symptoms develop. This can be tricky since the Drug Enforcement Administration requires clinicians who prescribe buprenorphine for outpatient use to have a waiver called an X license. The license requires eight hours of classes for physicians.

“That can become an issue when we’re transitioning a patient from the emergency department to a treatment clinic,” Carney said.

He said his goal is to get as many MarinHealth doctors as possible licensed. So far, 16 have signed up for training. Fortunately, in most cases medical providers with an X license at the Marin Treatment Center or Marin Community Clinics are able to see patients within one or two days, Carney said.

Carney is employed by Vituity, an Emeryville-based physician-owned health care company that operates MarinHealth’s emergency department. Carney is director of medication assisted treatment for Vituity.

Since arriving at MarinHealth Medical Center in 2017, he has ensured buprenorphine is available at the hospital and made its use part of the emergency department’s protocol.

“But as we see at many hospitals, it’s challenging to change the standard of care and train everybody,” Carney said. “It’s not something people necessarily learned in residency or when they were in medical school; it is something new.”

He said one question he hears frequently is whether the treatment trades one addiction for another. If someone takes buprenorphine every day, as patients in therapy need to do, their body develops a dependence on it, so if they suddenly stop taking it they will go into withdrawal.

The difference is that people who take opioids such as heroin, fentanyl, oxycontin, Norcal tablets and Percocet on a regular basis are so high they can’t function, and their lives fall apart, Carney said. With buprenorphine, they can take one pill a day and function normally.

“When I talk to my family member who takes insulin for their diabetes, I don’t say aren’t you just trading your diabetes for an addiction to insulin,” Carney said. “What we’re trying to do here is normalize the language and talk about this as a regular medical problem.”

MarinHealth has also hired a substance abuse navigator to provide followup care to patients. Carney said during his first month on the job in October the navigator saw 39 patients, 10 of whom had an opioid disorder.

The federal Substance Abuse and Mental Health Services Administration, which is supplying the funding for the MarinHealth grant, is also funding other efforts to boost the use of medication assisted treatment in Marin. Marin Treatment Center received $100,000 to increase the availability of medications for addiction treatment in criminal justice settings.

Since May 2018, the Marin County Department of Health and Human Services has been using Marin County Emergency Medical Services ambulance records to contact overdose survivors and offer them treatment.

Dr. Matt Willis, Marin County’s public health officer, said this and MarinHealth’s new program, “are basically two different approaches to the same problem.”

“As soon as you discharge patients from the emergency department,” Willis said, “there is a chance they’re going to fall through the cracks.”