November 08, 2019
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Bar Harbor hospital’s ER is prescribing meds for opioid withdrawal, but it’s not the only one

Courtesy of MDI Hospital
Courtesy of MDI Hospital
An emergency room at Mount Desert Island Hospital in Bar Harbor. MDI Hospital has become one of a few in the state that offer opioid withdrawal medication to emergency room patients.

Mount Desert Island Hospital has become one of a growing number of hospitals in Maine that are making opioid withdrawal medication available to patients in their emergency rooms — a move the hospital hopes will result in more people with opioid addictions in the area pursuing treatment.

The Bar Harbor hospital started stocking buprenorphine, also known by the brand name Subutex, in its ER this past summer. As of Monday, the hospital’s emergency department had started three patients on medication-assisted treatment, according to MDI Hospital spokeswoman Oka Hutchins.

Dr. Nathan Donaldson, the hospital’s emergency medical director, said the hospital decided to make the medication available after Mid Coast Hospital in Brunswick two years ago became the first hospital in Maine to prescribe buprenorphine — which lessens the severity of withdrawal and is a long-term addiction treatment — to patients who came into its ER.

“We want to be sure that we are doing everything that we can to combat this public health crisis,” Donaldson said. “On-demand opioid treatment works. Hopefully, every ER in Maine will have this available eventually.”

Last year, there were 354 drug-overdose deaths in Maine, with more than 68,000 deaths reported nationally.

The number of Maine emergency rooms offering opioid withdrawal medications has grown to 15 of the state’s 33 ERs in the two years since Mid Coast Hospital became the first, said Gordon Smith, Gov. Janet Mills’ director of opioid response.

Among those offering such treatment are Southern Maine Medical Center in Biddeford, Mercy Hospital and Maine Medical Center in Portland, MaineGeneral Medical Center in Augusta and St. Joseph Hospital in Bangor, Smith said. Northern Light Eastern Maine Medical Center in Bangor, one of the largest hospitals in Maine, plans to start offering opioid withdrawal medication in its emergency room soon, he said.

The goal is to have all 33 offering such treatment by the end of the year, Smith said, but the challenge is making sure those patients have access to regular, long-term treatment after being seen in their local ER. Federal law generally limits each patient to 72 hours of opioid withdrawal medication through a hospital’s emergency department. After that, Smith said, they have to receive treatment through a primary care provider or a certified substance use medical treatment program.

“I think it will improve our situation in Maine, in which people clearly will have more access to health care,” Smith said.

The ripple effects of addiction have spread into the criminal justice system, child welfare services, the economy and schools, Smith said. And, he added, Maine averages one overdose death a day.

“That’s like an awfully big airplane crashing in the state of Maine every year,” he said.

Hospitals that offer withdrawal medication to opioid-dependent patients in their ERs are helping to fill a much-needed gap in opioid treatment, hospital officials said. Until recently, ERs across the country only treated the symptoms of withdrawal when a patient came in — nausea or diarrhea, for example — but not the underlying cause of the symptoms.

But a 2015 study out of Yale-New Haven Hospital found that addicted patients who were given withdrawal medication during an ER visit were twice as likely to be in treatment a month later than patients who were given just information on where to find it, The New York Times reported last year.

At MDI Hospital, when an ER patient is ready to pursue addiction treatment, MDI Hospital connects him or her with Downeast Treatment Center in Ellsworth and other area providers.

Becky Schnur, spokeswoman for Maine Hospital Association, said that the biggest hurdle opioid-addicted patients face is getting into outpatient treatment, which can be hard to come by in some areas of the state.

“Providing addiction medication in [hospital emergency rooms] is a good start,” Schnur said. “Addiction medication in [an emergency room setting] is helpful and buys some time to make arrangements with addiction treatment providers, but is by no means the full answer.”

Based upon the volume of ER patients at Mid Coast Hospital who have been prescribed Suboxone in the past two years, MDI Hospital anticipates “a low volume” of about 10 patients during the first year of its program, said Hutchins, the hospital’s spokeswoman.



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