Medication-Assisted Treatment Induction

Medication-assisted treatment (MAT) is the use of medications along with counseling and behavioral therapies to treat substance use disorders (including OUD) and prevent overdose. There are medications available that are approved by the US Food and Drug Administration (FDA) for the treatment of opioid use disorder. As such, MAT is considered the gold standard for treatment of OUD and proven to be more effective than other treatments.  

MAT induction within hospitals is being explored across the US as hospitals continue to expand evidenced-based practices with the ED. Just like clinicians would administer lifesaving drugs to stabilize someone during a medical crisis, MAT is a medical intervention that can start in the ED and be sustained by outpatient providers.  

Key Takeaways for the ED 

  1. Address stigma and myths about MAT in the very beginning, even if not voiced by clinicians or staff.  
  2. Stigma and internal biases are sneaky. As your team is developing the MAT protocol, continue to compare how OUD patients are treated comparatively to other chronic illnesses in your ED.  
  3. MAT induction in the ED is very different than induction within the hospital. The “three-day rule”, described in this resource from SAMHSA, allows for practitioners to administer buprenorphine for acute withdrawal. It is important for these nuanced conversations to include EPs, senior leadership, and legal counsel.  
  4. Develop a strong relationship with at least one community-based MAT provider. If one does not exist in your community, consider how to expand capacity within primary care offices – especially if you are part of a health system.  
  5. There is not just one type of MAT. Continuity of care and MAT accessibility within the patient’s community (i.e., transportation, insurance), among other clinical considerations, should be prioritized when referring to an outpatient MAT provider.  
  6. To encourage ED physicians to become waivered, consider how to tie to compensation, desirable shifts, or other benefits.  
  7. Stay up to date on best practices by joining a Project ECHO specializing in MAT 

Resources to Get You Started 

Provider Resource from MAHEC, NCDHHS, AAAP: MAT Policies, Procedures, and Resources Manual.

NCHA convenes a virtual bi-monthly, peer-led, implementation group meetings for ED clinicians and administrators on topics from the ED Opioid Treatment Pathway.
MAT Treatment induction in the ED | Feb 2020
Slides (PDF)
Recording (YouTube)

Learn about the basics of MAT 

Seven Myths about MAT for OUD 

MAT in the Emergency Medicine Setting 

To learn more about upcoming DATA 2000 waiver trainings across North Carolina, visit the Governors Institute here 

NC DHHS Buprenrophine Guidance Document

Guidelines for Medication for Addiction Treatment for Opioid Use Disorder within the Emergency Department 

Clinical Opiate Withdrawal Scale (COWS) 

Treatment Algorithm for Withdrawal Symptoms from NIH

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