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ED Medications for Opioid Use Disorder (MOUD) Access Project

Hospital EDs across the country have seen an increase in patient visits for opioid overdose. Specifically, MUSC Charleston has seen a 100% increase in the last decade, which led to the formation of its ED Medications for Opioid Use Disorder (MOUD)  Access Project with the following components: 

  • SBIRT (Screening, Brief Intervention, and Referral to Treatment) to identify those with substance abuse and those who have higher levels of risk 
  • ED-Initiated Buprenorphine 
  • Peer Recovery Services 
  • Harm Reduction – naloxone distribution, fentanyl test distribution, patient education 

By following above, plus changing culture in the ED, MUSC Charleston is stabilizing screened patients by initiating buprenorphine, reducing patients’ withdrawal symptoms and cravings, and connecting them to treatment outside the hospital. The project has been expanded to 10 additional hospitals throughout SC. 

The following clinicians – MDs, physician assistants (PAs), and advanced practice registered nurses (APRNs) – can prescribe buprenorphine with a referral for ongoing treatment. See SAMHSA’s website for more information on why the DATA waiver (X-waiver) is no longer needed to prescribe buprenorphine. 

For MUSC, an important piece of culture change included removing the stigma around Opioid Use Disorder (OUD) by educating all ED staff that it is a treatable and chronic brain disease. MUSC also developed a workflow protocol for ED physicians to use and determine buprenorphine initiation to appropriate patients. This protocol is available throughout the ED and is included in the health system’s medical software (Epic). 

In addition, MUSC added peer support staff who interact with OUD patients drawing from their own lived experiences and knowledge of recovery from addiction. They offer recovery support, education, mentorship, resource navigation, advocacy, Naloxone distribution, and a warm handoff and assistance with entry to treatment. Since 80% of OUD patients are uninsured or without funding, peer support staff schedule patients for standing next-day appointments at local alcohol and drug abuse authorities (DAODAS 301 agencies) for outpatient treatment. Before discharge, OUD patients are educated on safer-use strategies to help them stay safer and healthier no matter what decisions they make. 

Hospital EDs are important partners in initiating buprenorphine treatment for patients with OUD, leading to better outcomes and improved patient care.  

For more information, contact Lindsey Jennings, M.D., MPH, at jennil@musc.edu. Dr. Jenning is MUSC’s Assistant Program Director for the Emergency Medicine Residency Program and the Fellowship Director for the EM Medical Education Fellowship.