Medications for Opioid Use Disorder Program in a VA Emergency Department

Hsiao JJ, Celedon MA, Basrai ZI, Sasson C, Cordasco KM. Medications for Opioid Use Disorder Program in a VA Emergency Department. MDEdge: Federal Practioner [Internet]. 2022 Oct 20:(MDedge):258618. Available from: https://www.mdedge.com/fedprac/article/258618/addiction-medicine/medications-opioid-use-disorder-program-va-emergency.

Background: Opioid use disorder (OUD) is a public health crisis significantly affecting veterans. Providing medications for opioid use disorder (MOUD) can increase engagement with addiction treatment. Although emergency departments (EDs) throughout the United States are beginning to provide this life-saving treatment, little is known about how this can be applied to the US Department of Veterans Affairs (VA) health care setting. Observations: Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) ED developed the first VA ED MOUD program in an 8-step process. Following stakeholder buy-in, we developed the protocol, determined appropriate follow-up, identified eligible veterans, developed supporting tools and resources, modified organizational policy and processes, educated clinicians about the protocol, and evaluated the results. Veterans treated with MOUD were given follow-up appointments within 2 business days in the VAGLAHS SUD clinic or referred directly to a substance use rehabilitation center. Conclusions: This program demonstrates the feasibility of an ED bridge program at a single VA facility that could be expanded to other VA medical centers. Patients who received buprenorphine in the ED were more likely to remain engaged in addiction care; however, many patients lacked symptom severity to be initiated in the ED. Offering home initiation and increasing OUD screening may help increase enrollment. With increased OUD overdose rates during the COVID-19 pandemic, expanding access to MOUD is essential to combating this crisis.