FEATURE | Posted May 8, 2019

Treating substance use disorder in California emergency departments

Prescription medicine, on-site counselors essential to helping patients with addictions

When Eileen Morley attended a two-day training at UC Davis Health, she was eager to establish the 24/7 treatment program for substance use disorders in the emergency department (ED) at Adventist Health and Rideout Hospital.

Dr. Morley in Rideout's ED speaking with a patient
Eileen Morley, assistant director of emergency medicine at Adventist Health and Rideout Hospital

As the only emergency room between South Butte County and Roseville, Rideout’s team of 35 physicians, nurse practitioners and physician assistants treat 72,000 ED patients a year. Many of these patients are on Medi-Cal or are homeless.

“We have a large coverage area and see a lot of patients who are socioeconomically disadvantaged,” said Morley, assistant medical director of emergency medicine at Rideout. “Patients often have a hard time accessing health care services and many struggle with substance use issues, including with methamphetamines, opioids and alcohol.”

Medication for substance use disorder essential to successful treatment

In March, Morley was one of more than 40 physicians and counselors in California who attended substance use navigator (SUN) training. The training series gives participants a comprehensive set of tools to care for patients with substance use disorders. It was co-led by Aimee Moulin, associate professor of emergency medicine at UC Davis Health and co-principal investigator of California Bridge.

“The program guides emergency departments in complying with rules that allow physicians to prescribe buprenorphine, a unique schedule III opioid that blocks the effects of heroin,” Moulin said. “It also supports the hiring of on-site counselors who work closely with emergency patients to help get them into recovery programs in the community.”

It’s an initiative that is sorely needed, emergency physicians say. “We’re starting from square one,” Morley said. “Like a lot of other EDs, we had a list of recovery programs in the community but not the certification required for our physicians to prescribe buprenorphine. Our ED also didn't have a substance use navigator ̶̶ few currently do. We can have all of the medical knowledge and training in the world, but without a navigator to help arrange follow up after an ED visit, treatment for substance use disorders isn’t going to succeed.”

Evidence-based medicine for substance use disorders

The SUN program is a critical component of California Bridge’s model for medication for opioid use disorder treatment, and teaches hospital champions best practices for treating substance use disorders as well as the medical model of addiction. The goal is to help reduce the stigma of addiction, which is often incorrectly considered a moral weakness. It also aims to build stronger ties with counselors and providers at addiction treatment centers.

Opioid use disorder, caused by the prolonged use of heroin or opioids – prescription or otherwise – is estimated to affect more than 2 million people in the U.S.

According to the Patterns of Opioid-Related Overdose Deaths in California, 2011-2017, there were 2,199 overdose deaths involving opioids in California in 2017 — a rate of 5.3 deaths per 100,000 persons. The majority of these overdose deaths (70%) were caused by prescription opioids. However, the greatest increases in opioid deaths involved synthetic opioids (fentanyl) and heroin.

California Bridge is a program of the Public Health Institute and offers the training through the Substance Abuse and Mental Health Services Administration (SAMHSA) State Targeted Response to the Opioid Crisis Grant to the California Department of Health Care Services (DHCS).

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