September 12, 2018
Hospitals statewide are turning to Buffalo emergency department doctors for best practices in dealing with opioid addiction.
Local emergency medicine physicians last summer developed standardized prescribing guidelines that were adopted by hospitals throughout the region, helping to prevent doctor shopping and letting patients know they could expect the same treatment at every site.
Step two was getting more than 100 ER physicians at seven hospitals affiliated with UBMD Emergency Medicine trained to administer buprenorphine, a drug that helps patients in withdrawal.
Shortly after, they secured agreements at several clinics to accept patients for assessments within 48 hours, no matter what their health background or insurance was. By spring, participating outpatient clinics totaled 27, giving patients more flexibility and convenience in choosing where they could pursue care.
Now the program, which started with six hospitals affiliated with Kaleida and Erie County Medical Center, is expanding to Catholic Health hospitals. State officials are asking physicians here to help other regions of the state establish a similar system.
“Our program is more robust than what they’re doing out in California and, frankly, more of a comprehensive program than what most people around the country are doing and has been for a while,” said Dr. Joshua Lynch, director of pre-hospital care at Millard Fillmore Suburban Hospital.
He has led the program and said it gives patients a better chance of overcoming addiction by providing immediate relief from symptoms.
“It’s also a prime example of unprecedented collaboration between competing agencies,” Lynch said.
Dr. Paul Updike, who runs Catholic Health’s addiction clinics and recovery programs, said ER physicians are being trained and that outpatient clinics are fully on board.
“We are planning and we have the intention to be fully participating in this model,” Updike said. “This has been quite an effort and collaboration, and in that regard it’s unique. That’s to Dr. Lynch’s credit and everyone involved.”
Indeed, the community is coming together to fight a larger battle. Dr. Gale Burstein, Erie County health commissioner, said the local region is ahead of the curve statewide and nationally.
“Catholic Health and Kaleida have decided to lay down their sabers,” Burstein said. “They have the same goal – to help the community overcome this opioid overdose epidemic. Unfortunately, there’s more than enough business for everyone in this field, so it does not make any sense to be competitive in this.”
Updike agreed, saying the pure devastation of the epidemic is something that cannot be ignored.
“That pushes people into places they wouldn’t have gone before,” he said, “and that’s good. There’s nothing we’ve done here that’s that mysterious or complicated that couldn’t be done in other places.
“That being said, you need people to pick up the flag. You do need to find advocates, champions, and we’re fortunate to have that.”
Robert McCormack, chairman of UB Emergency Medicine, said expanded relationships between the hospitals and clinics has been key.
“The truly unique part here is the warm handoff,” he said. “We had enough consensus to say yes, this is the right thing to do, and people bought into that. The idea is this wasn’t putting new services out there; this was coordinating competing services.”
As recent as two or three years ago, emergency medicine physicians didn’t see themselves playing a role in chronic medication management. Now there’s widespread acceptance, McCormack said.
“The extent of the epidemic made us think differently,” he said. “You’re seeing these kids, and adults, die on a daily basis. We said we need to be able to do something here. So having emergency medicine physicians prescribe buprenorphine, we’re definitely on the beginning of the curve.”
Lynch, who serves on a statewide buprenorphine work group established by the state Department of Health, has begun sharing the local model. He has visited emergency medicine physicians on Long Island and elsewhere and explored development of a toolkit for how to get it done. Though the local program was supported by grants from the John R. Oishei Foundation, state funding could be available to hasten the development of similar networks elsewhere.
“The key to having this be reproducible is the fact that we built this on a community model,” he said. “UB didn’t have 10 addictions clinics under its umbrella. We had 10 different organizations in the community that compete with each other that we needed to get together to work with us.”