MHA has released these guidelines
to assist hospitals develop appropriate programs to administer and/or prescribe Medication for Addiction Treatment (MAT) in their emergency departments or satellite emergency facilities. A new state law (Chapter 208) requires acute care hospitals that provide emergency services to have the capacity to initiate opioid agonist therapy to patients after an opioid-related overdose, and to directly connect the patients to continuing treatment prior to discharge.
“MAT is a very effective treatment option, and emergency departments offer a real opportunity to reach patients in that critical moment following an overdose,” said Ali Raja, M.D., the executive vice chair of Massachusetts General Hospital’s Department of Emergency Medicine, who chaired the MHA workgroup on MAT. “These guidelines share best practices for adoption of MAT in emergency departments, facilitate training and credentialing for ED clinicians, and identify ways to ensure continuity of care after patients are discharged. It’s all designed to give the clinicians the tools they need to accomplish the ultimate goal of supporting patients as quickly as possible and help them get their lives back.”
MHA President & CEO Steve Walsh said, “While recent statewide data has shown improvements, our nation’s opioid epidemic continues to ravage our communities and take far too many lives. How we manage this crisis in our hospitals is of utmost importance. These MHA guidelines are designed to provide a practical resource for hospitals and clinical staff to help fulfill the requirements in the commonwealth’s latest opioid law, championed by Governor Baker and the legislature. The procedures aim to ensure that patients with opioid use disorders can start their treatment and get on the road to recovery before they leave the hospital.”
The new MHA guidance document provides general recommendations for development of an in-hospital MAT program, using best practices from several Massachusetts hospitals as well as facilities in other states that have or are considering MAT adoption. Each hospital is encouraged to consider and implement recommendations that are appropriate for their facility.
The guidelines also include an explanation of the requirements for clinicians to obtain a federal “X Waiver” to prescribe MAT, information on the laws and regulations currently in place to allow hospitals to discharge patients with a take-home kit of buprenorphine, a general Q&A section for clinicians, and template fact sheets to educate patients on the use of buprenorphine.
MHA developed the recommendations in collaboration with the Massachusetts College of Emergency Physicians and with practitioners from member hospitals, including specialists in emergency medicine, addiction medicine, behavioral health, and nursing. MHA has hosted two X-Waiver trainings and is coordinating additional trainings in January.
The guidelines for MAT in Massachusetts hospital emergency settings further advance the ongoing efforts of MHA and the Massachusetts hospital community to curb the opioid crisis. Earlier this year, MHA and Tufts Medical Center, working with hospital clinicians and operational staff in Massachusetts and other states, developed two documents to help hospitals develop internal policies to prevent opioid misuse by patients admitted as inpatients for care and treatment. Caregivers across the state now also have access to Prescription Monitoring Program (PMP) information through MassPAT, and MHA is working with providers to enable even faster access to this information.
Previously, MHA convened a task force that included a multi-disciplinary group of clinicians and operational staff to create and issue an array of guidance and informational sheets to improve opioid prescribing practices and screening for OUD within hospitals, as well as to enhance patient education concerning the potential risk and harm of opioid use and possible alternative treatments. All of these guidance and educational materials are available on MHA’s PatientCareLink
In November 2018, DPH’s most recent report on the opioid epidemic showed prescribing of opioids in the state had fallen by 35% from the first quarter of 2015 to the third quarter of 2018.