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News & Press: Legislative and Regulatory News

Update on the Opioid Epidemic

Tuesday, May 26, 2020  
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Written By: David E. Zimmerman, PharmD, BCPS, BCCCP
Associate Professor of Pharmacy at Duquesne University School of Pharmacy
EM Clinical Pharmacist at UPMC-Mercy Hospital

On April 28, 2020, the DEA released additional guidance for patients on medication assisted treatment (MAT) that allows for delivery of take-home doses for patients taking buprenorphine/naloxone. Follow this link to see the full letter from Drug Enforcement Administration. This is an update to an April 7, 2020 guidance document that allowed for a similar measure with methadone. This is a necessary and important step to ensure patients with opioid use disorder (OUD) receive life-saving treatment during the COVID-19 pandemic. And hopefully, this will lead to a permanent change and allows MAT to be more accessible to patients with OUD.

In local news, emergency departments (ED) across the state are stepping up to combat the opioid epidemic. How can your institution get started? Well one place to start is to first review the PA Department of Health “Treatment of pain in an emergent setting Guidelines”. There are numerous recommendations about prescribing (or not prescribing) that should serve as best practices in your ED. 

One example includes writing prescriptions for naloxone or even simply discharging patients with a “to-go” supply. This way we can put the life-saving therapy directly into the hands of the patient without the concern of whether the patient can get to an outpatient pharmacy and/or afford the prescription. Another great example is taking place in the “West Coast” (of the state) as part of the Allegheny County Substance Use Emergency Care Collaborative. This Collaborative is made up of members from UPMC, AHN, Heritage Valley, St. Clair, and the Veterans Affairs and is working toward ensuring patients with OUD have increased access to treatment. One example is where emergency medicine prescribers are initiating buprenorphine/naloxone in the ED and then connecting patients to an outpatient facility. 

There are various algorithms out there for dosing in the ED with some based off of the original D’Onofrio study published in 2015. This is not a job for a single person but instead relies on a team effort of prescribers, nurses, social workers, pharmacists, administration and others to ensure the process runs smoothly. What about that pesky X-waiver? Well, prescribers that are X-waivered can write a prescription for a short course of buprenorphine/naloxone to get filled at an outpatient pharmacy in situations where a patient may not be able to go directly to the outpatient detox facility. 

But what if it’s a Friday or Saturday night? Well another possibility is for the patient to return each day to the ED to get a dose until they can get into a clinic on Monday. But what if your EM prescribers do not have an X-waiver and the patient does not want to return to the ED every day? Well the most recent addition at UPMC ED’s is the use of Tele-health to help meet that need. In these circumstances, EM clinicians who do not have an X-waiver can consult the UPMC Toxicology service 24/7 and an attending can evaluate the patient and initiate and/or prescribe buprenorphine/naloxone. 

These are just a couple of examples on the impact we can have in combating the opioid epidemic. Please note, this is not just a West Coast (of PA) thing either. I know of similar programs ongoing at institutions in the City of Brotherly Love and other areas of the state. What this shows though, is together, we can help tackle the opioid 

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