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May 3, 2018

Mid Coast Hospital is first in Maine to prescribe Suboxone in ER

Courtesy / Mid Coast Hospital
Courtesy / Mid Coast Hospital
In a new initiative to help people overcome opioid addiction, Mid Coast Hospital in Brunswick is the first hospital in Maine to begin prescribing Suboxone in its emergency department.

About Mid Coast Hospital

Mid Coast Hospital is a full-service, 93-bed, independent, not-for-profit hospital governed by a community board of directors. The active medical staff includes more than 200 providers in over 30 primary care and specialty areas. Mid Coast Hospital is accredited by The Joint Commission, and is recognized as a Magnet facility by the American Nurses Credentialing Center for exceptional nursing and patient care.

In a new initiative to help people overcome opioid addiction, Mid Coast Hospital in Brunswick is the first hospital in Maine to begin prescribing Suboxone in its emergency department.

Citing a 2015 study reported by Yale University, Mid Coast said its new approach is based on the finding that early intervention by a team of emergency department physicians and behavioral health providers can result in better outcomes for people struggling with an opioid addiction.

"Combined substance abuse and mental health treatment with FDA-approved medication for opioid dependence has shown a significant increase in patient access and improved outcomes," said Dr. Leah Bauer of Mid Coast Hospital Addiction Resource Center. "Medications stop withdrawal and relieve cravings so patients can have the best chance of engaging in successful treatment."

The ED/ARC (Addiction Resource Center) Enhanced Referrals for Suboxone and Alcohol program always emergency physicians to treat low-risk alcohol withdrawal and opioid withdrawal and to begin treating patients with Suboxone while they are still in the emergency department. The program provides a screening tool for physicians and includes the emergency department's behavioral health crisis team.

In most cases, the patient leaves the emergency department with an appointment at the Addiction Resource Center on the next business day, thereby ensuring that the treatment process begins quickly with a pathway to ongoing comprehensive treatment for the addition, according to the hospital.

"The model is based on taking advantage of the opportunity to intervene that an emergency department physician has when a patient with addiction presents," said Dr. Ranjiv Advani of Mid Coast Hospital's emergency department. "If that opportunity is not seized at that moment, it may not present again."

Why this is important

Maine, like many states, is struggling with how to stem the use of drugs, including opioids, and treat those who become addicted. In 2017, there were 418 drug-induced deaths in Maine, up 11% from 2016.

Prior to Mid Coast Hospital's initiative, there wasn't a system in place for an emergency department physician to easily help a willing patient access the services of the Addiction Resource Center. With its ability to schedule new patients promptly, Mid Coast Hospital said its Addiction Resource Department "stands apart from many recovery programs in Maine that take weeks or months to access."

"The delay often is a deterrent for people who struggle with addiction," said Bauer. "This 'soft landing' can be the difference for patients, especially those who have a narrow window of motivation to begin recovery."

Not all patients are willing to proceed with the fast-track process, Mid Coast acknowledged in its news release.

The hospital reported that its team has screened many patients in the ED who are not ready or willing to engage in treatment.

Nevertheless, between the start of the program in mid-October and the end of January, the hospital reported that 11 patients were referred to the Addiction Resource Center, and nine arrived at their first treatment session there.

Bauer said in March Mid Coast Hospital began treating a 34-year-old father of an 18-month old, "who had extensive history of misuse and previous treatment episodes."

"He had an accidental overdose, which was a wake-up call for him and led him to seek treatment in the emergency department to fast-track his addiction treatment," Bauer said. "We began seeing him the following week and now several weeks later, he continues his treatment at ARC, his relationship with his partner has improved, and he is a successful stay-at-home-dad. Stories like these are a testament to how this program can help improve lives and bring people back into functioning roles in society."

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