Medication-Assisted Treatment in the Emergency Department Boosts Recovery from Opioid Use Disorder

As the devastating consequences of the nation's opioid crisis continue, our Emergency Department (ED) physicians are helping more people recover using medication-assisted treatment (MAT) as part of a whole-patient approach to opioid use disorder.
"We see so many people in the ED who are suffering and eager to get well, and MAT is a highly effective, evidence-based therapy that we can now use to help our patients,” says Brenda Foley, MD, medical director of the Emergency Department at Doylestown Hospital.

“Substance use disorder is a chronic medical disorder that affects men and women of all ages, races, and geographic locations,” says Dr. Foley, noting that addiction to opioids and other substances is not due to a flawed character or lack of willpower. “It is vital that we eliminate judgment or stigma around this disease, break down barriers, and make this an accessible treatment to all who need it.”

A Dimmer Switch for Opioids

Substances like opioids flood your brain with dopamine, the chemical messenger that signals the brain to associate drug use with intense pleasure, according to Dr. Foley. "The brain records the substance as essential, remembering people, places, and related activities. Eventually, the substance feels like something you cannot live without — it becomes the only thing that is important to you," she says.

The hospital offers MAT in the form of buprenorphine, which includes the brand name Suboxone®. This medication acts as a dimmer switch on the opioid receptor, according to Dr. Foley. It blocks the effects of other opioids, while also activating the opioid receptor in a minimal way (unlike highly activating drugs such as fentanyl or heroin).

“These unique characteristics mean that MAT can help relieve withdrawal symptoms, reduce cravings, and give patients a clearer head, enabling them to begin and continue the path to recovery with a higher likelihood of sustained sobriety,” she says. “People who take the medication typically start feeling better within an hour.”

"MAT is one of the most effective interventions to treat opioid use disorder, and it also helps with the painful effects of withdrawal,” says Dr. Foley. “We are seeing fewer patients being readmitted to the hospital or leaving before they are medically stable, with fewer complications," says Dr. Foley. A recent study in the American Journal of Preventive Medicine found that Suboxone and other forms of the medication have shown a 50% to 60% reduction in mortality among people with opioid use disorder.

A patient must be in withdrawal to qualify for Suboxone, a film that dissolves in the mouth over time. "If a patient is not ready for medication, we make sure they know we are here for them," says Dr. Foley.

A Warm Handoff

In addition to medication, a certified recovery specialist (CRS) is available 24/7 to provide bedside counseling in our ED. This resource of face-to-face, real time care is an essential component of an overall impactful plan of recovery for the patient, according to Dr. Foley. "A CRS can literally and figuratively hold the hand of a patient in his or her first steps to recovery,” she says. “This approach has been instrumental in getting patients counseled, educated, and directed toward treatment.”

Linking Patients with Follow-up
Treatment and Support

“Our team guides patients to recovery care and resources to help ensure that each patient may be seen after discharge, so that they may continue with a comprehensive treatment plan, which may include MAT,” says Dr. Foley.

Better Outcomes with MAT

A 2020 comparative study published in JAMA Network Open showed that treatment with MAT (with buprenorphine or methadone) was associated with reductions in overdose and serious opioid-related acute care use when compared with other treatments. Researchers found that MAT:

• Reduced opioid overdoses 76% at three months and 59% at 12 months
• Decreased serious opioid-related acute care use at both three and 12 months  

Understanding Substance Use Disorder

Developing a Tolerance

Repeated substance use makes the brain's receptors less sensitive to the drug. It takes more and more of that drug to produce the same effects. With continued use, you may become dependent, so that you feel that you can only function in the presence of that drug because your brain has adapted to repeated use.

Withdrawal Can Be Severe

Another hallmark of addiction is withdrawal. If you are a person with addiction and you cannot regularly access the substance, the receptors in your brain are impacted, and your and body will exhibit the symptoms of withdrawal.
Withdrawal symptoms can range from very uncomfortable to life threatening, depending on the substances you are using. With opioids, withdrawal can be excruciatingly uncomfortable, according to Dr. Foley. With benzodiazepine (Xanax) or alcohol, withdrawal symptoms can be life threatening.

Continuing Despite Consequences

People with opioid use disorder also experience a compulsion to continue to use the drug. This compulsion can be very powerful, despite adverse consequences. "Using drugs to feel normal and avoid withdrawal becomes a daily goal leading to a terrible cycle of never feeling well and trying to overcome these cravings," explains Dr. Foley.

Learn More

Medication Assisted Treatment (MAT) is just one part of an overall treatment plan for recovery from opioid use disorder.

• For information about substance use disorder treatment and recovery resources, visit Bucks County Drug & Alcohol Commission, Inc., or call 215.444.2700.
• 24/7 telephone access is available by calling PA Get Help Now at 1-800-662-HELP (4357).

Further Reading

• To learn more about treatment for Opioid Use Disorder, visit the Centers for Disease Control and Prevention, Recovery is Possible: Treatment for Opioid Addiction.
• To read the comparative study about MAT and other treatment pathways, visit JAMA Network Open, Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. 
• The research on mortality and opioid use disorder appears in the American Journal of Preventive Medicine, Buprenorphine After Nonfatal Opioid Overdose: Reduced Mortality Risk in Medicare Disability Beneficiaries.