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Post-Overdose Care in the

Emergency Department 

Medication for opioid use disorder (MOUD)

Medication for opioid use disorder (MOUD) combines behavioral therapy and medications to treat substance use disorders. MOUD is effective in the treatment of opioid use disorders (OUD) and can save lives by helping to prevent relapses as well as help some people to sustain long term recovery.

*Historically, pharmacological treatment for opioid use disorder was referred to as “Medication Assisted Treatment” (MAT).” More recently, it has been determined that the better term is “Medication for Opioid Use Disorder (MOUD)” since it precisely describes this treatment form and carries less stigma. While many valuable resources in the Michigan Safer Opioid Prescribing Toolkit still use the term “MAT,” our website will refer to it as “MOUD” going forward.

Sample Protocols

MOUD Protocols

  • Download these sample clinical MOUD protocols developed by CA Bridge and the Alaska Department of Health and Social Services and adapt for use in your emergency department.
  • Sites will need to evaluate whether these sample clinical MOUD protocols are appropriate for their ED and obtain proper committee approval before use.

What is Medication For Opioid Use Disorder (MOUD)?

SAMHSA: Pocket Guide – MAT for Opioid Use Disorder

  • Download this 16-page pocket guide for quick access to information on MOUD –find a checklist for prescribing medication, medications approved in the treatment of OUD, and a clinical opiate withdrawal scale.

Locate a MOUD Specialist

 

SAMHSA – Buprenorphine Treatment Practitioner Locator

  • Find practitioners authorized to treat opioid dependency with buprenorphine by state.

SAMHSA Opioid Treatment Program Directory

  • View opioid treatment programs by state.

Washtenaw Health Initiative Opioid Project

  • Find resources on how to get help and support for an opioid addiction in Washtenaw County, Michigan.

ASAM – Patient Resources

  • Access this site to learn more about addiction, addiction specialists, and how to locate an addiction specialist.

MOUD Waiver Training and Support

 

Information to help physicians and other medical providers to get the training they need to provide MOUD to their patients.

 

Overview of Medication Assisted Treatment – PCSS Providers Clinical Support System

  • Learn about MOUD waiver training for physicians, nurse practitioners, and physician assistants and access an introduction to MOUD.

American Society of Addiction Medicine (Live & Online CME)

  • Visit this website to access live and online CME opportunities focusing on improving the care and treatment of people with the disease of addiction.

MOUD in the Emergency Department

 

Summary of MAT in ED Resources Handout

  • Download this handout for a comprehensive summary of the MOUD resources in this toolkit.

AAEM: Buprenorphine White Paper

  • This 37-page white paper details the Management of Opioid Use Disorder in the Emergency Department.

SAMHSA: Use of Medication-Assisted Treatment in Emergency Departments

  • This guide examines emerging and best practices for initiating MOUD in emergency departments. It also reviews the existing literature and science of the topic, identifies gaps in knowledge, and discusses challenges of implementation.

CA Bridge: Blueprint for Hospital Opioid Use Disorder Treatment

  • A patient-centered guide to MOUD in your hospital.

California Bridges Model

  • This comprehensive model was developed by an interdisciplinary team based on published evidence and expert opinion. Includes protocols for initiating MOUD; how to treat acute pain in patients on MOUD; provider and patient education; sample order sets; pregnant patient considerations.

ACEP: Buprenorphine use in the Emergency Department Tool: BUPE

  • This one stop website contains critical materials for if you are considering starting MOUD for a patient. Compatible smart phone application available for ACEP members.

Washington ACEP: MAT in the ED

  • The Washington ACEP has provided five 1-2 page PDFs with essential information for providers and patients on initiating medication-assisted treatment for patients presenting to the emergency department with opioid withdrawal.

Yale: ED-Initiated Buprenorphine

  • Contains resources including videos modeling conversations between provider and patient for post overdose, teens, and OUD.

Herring; Highland Hospital: ED MAT of Opioid Addiction

  • Comprehensive 50-page paper with discussion of the evidence for MOUD in the ED and proposed models for how this might look in different EDs

Securing Buy-In for MAT

  • Reference this handout for information on how to secure buy-in for MAT in your ED.

MOUD Guidelines

 

SAMHSA Tip 63 Manual

  • This Treatment Improvement Protocol (TIP) reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat opioid use disorder (OUD)—methadone, naltrexone, and buprenorphine—and the other strategies and services needed to support recovery for people with OUD.
  • Scroll down to open the document.

Boston Medical Center OBAT Manual

  • Access both a versions of the Office-based Addiction Treatment (OBAT) Clinical Guidelines Manual –one to be used by health centers in Massachusetts and one with more general, non-Massachusetts specific information on the Nurse Care Manager model of OBAT.

MDHHS MAT Guide

  • Review this resource for current evidence that can guide the treatment, safety, efficacy and payment models driving the treatment of opioid use disorders.

The ASAM National Practice Guide for the Use of Medications in the Treatment of Addiction Involving Opioid Use

  • These guidelines provide information on evidence-based treatment of opioid use disorder, and addressing all of the FDA-approved medications available to treat addiction involving opioid use and opioid overdose.

Substance Use Disorder and Opioid Use Disorder Assessment Tools

 

For more screening tools, visit the Screening for OUD section of this toolkit.

 

ASAM Screening tools

  • Access screening and assessment tools for alcohol and drug use among patients.

The AUDIT (Alcohol Use Disorder Identification Test)

  • Access the AUDIT, a simple method of screening for excessive drinking and alcohol use disorders.

DAST-10 (Drug Abuse Screen Test)

  • Access the DAST-10, a survey administered by the clinician or self-administered by the patient used to screen for drug abuse.

CRAFFT

  • A behavioral health screening tool designed for children under the age of 21 to access for drug and alcohol use.

Opioid Risk Tool

  • A brief, self-report screening tool designed for use with adult patients in primary care settings to assess risk for opioid abuse among individuals prescribed opioids for treatment of chronic pain.

COWS

  • Assess this clinical opiate withdrawal scale to access –a Flowsheet for measuring symptoms over a period of time during buprenorphine induction.

Assessment Tools for Co-morbid Mood Disorders

 

Generalized anxiety scale (GAD) –GAD 7

  • Screening tool that identifies if a complete assessment for anxiety is recommended.

Patient Health Question (PHQ-9)

  • 9 item depression assessment to determine severity of depressive symptoms and indicate if a depressive disorder should be considered.

Ongoing MOUD and Substance Use Disorder Training

 

Boston Medical Center Office Based Addition Treatment Training and Technical Assistance

  • The BMC OBAT Training and Technical Assistance provides education, support and capacity building to community health centers and other health care and social service providers on best practices caring for patients with substance use disorders. Learn more about BMC’s OBAT TTA services or request TTA.

PCSS Module 4: Medication and Behavioral Treatment of Substance Use Disorders

  • Introduces evidence-based clinical practices of pharmacotherapy and behavioral treatments for substance use disorders. Off label medications and psychosocial support programs are also discussed.

ASAM – Treatment of Opioid Use Disorder Course (includes waiver qualifying requirements)

  • The course covers all forms of medications and treatments of opioid use disorder, and provides the required education needed to obtain the waiver to prescribe buprenorphine.

Talking to Patients about MOUD

 

Listen to Physicians and Patients Discuss Treatment Options

  • Watch this video to learn more about techniques for talking to patients about medication assisted treatment.

Supplemental Resources

 

ACEP: E-QUAL Network Opioid Initiative

  • This one stop website has critical materials regarding reducing opioid associated harms, including a Toolkit; Pocket cards; Lectures; etc.

SAMHSA Publications on MAT

  • Find and download free publications, apps, and other resources on treatment, prevention, and recovery for mental and substance use disorders.

SAMHSA Medication-Assisted Treatment (MAT)

  • Visit this site to gain information on MOUD including medications to treat opioid addiction, information and training resources, statues, regulations and guidelines and certification of OTPs.

Michigan Opioid Collaborative (MOC)

  • Access resources, webinars, prescribing guidelines and screening tools for MOUD.