ECHO Resources

Guidance

• ED OUD Treatment Playbook: Includes resources on how to treat OUD in ED and implement organizational change, American Academy of Emergency Medicine (AAEM) White Paper: A white paper on management of OUD in ED. Includes medication initiation and considerations of patient morbidities and other factors.
• ACEP Information Paper: Discussion of transitions of care models for OUD patients from ED to outpatient settings. Includes suggestions for staffing models to coordinate transitions.
• ACEP: Models for Addressing Transitions of Care for Patients with Opioid Use Disorder: An Information Paper (American College of Emergency Physicians (ACEP)): Discussion of transitions of care models for OUD patients from ED to outpatient settings. Includes suggestions for staffing model to coordinate transitions.
• ACEP ED Naloxone Distribution: Key Considerations and Implementation Strategies (American College of Emergency Physicians (ACEP))
• TIP 63: Medications for Opioid Use Disorder – Executive Summary & Full Document: Guideline for Treatment of Opioid Use Disorder that includes topics on screening, assessment, diagnosis and management, follow-up, and referral. Includes guidance for MAT management in ED and inpatient settings.
  • Executive Summary
  • Full Guideline
• How to Pay for It: MAT in the Emergency Department: FAQ (California Health Care Foundation (CHCF)) 

Substance Use Navigators/Peer Support

• Peers (Substance Abuse and Mental Health Services (SAMHSA))
• Substance Use Navigators: The SUN is a hospital employee embedded within either an emergency department or an inpatient setting to help patients begin and remain in addiction treatment.
• Christiana Care Health’s Project Engage: Program that screens ED patients who exhibit signs of a substance use disorder, and asks them if they would like to talk to a peer counselor about the problem; if they say yes, the counselor works with a hospital social worker to connect patients with community resources that put them on the path to recovery.
• A Qualitative Study on Peer Support Workers: A study from the National Council on engaging individuals surviving opioid overdoses (Peer Support Workers) in Emergency Departments

Examples of ED OUD Programs

Minnesota Programs

• Hennepin Emergency Medical Services, MPR News

National Programs

• Project ASSERT: To improve Alcohol and substance Use Disorder Services, Education, and Referral to Treatment (Boston Medical Center): Project ASSERT was the first nationally published program in an ED to deploy peer counselors/educators as motivators and navigators to identify and intervene with patients with unhealthy alcohol and drug use. The Project ASSERT team of outreach workers provided the “in-reach” that the ED staff needed to bridge the gap between what patients needed and what they had the capacity to provide.
• Christiana Care Health’s Project Engage (American Hospital Association (AHA)): Program that screens ED patients who exhibit signs of a substance use disorder, and asks them if they would like to talk to a peer counselor about the problem; if they say yes, the counselor works with a hospital social worker to connect patients with community resources that put them on the path to recovery.
  Emergency Care for the Opioid Epidemic: Leaders Discuss Medication-Assisted Treatment in the ED (California Health Care Foundation (CHCF)): CA focused, but may be helpful to others to understand what’s needed to implement
• A Qualitative Study on Peer Support Workers: A study from the National Council on engaging individuals surviving opioid overdoses (Peer Support Workers) in Emergency Departments

Guidance

• Acute Care: Addiction Medicine for the Hospitalist
• Blueprint for Acute Care Hospital use of Buprenorphine
• Blueprint for Hospital Opioid Use Disorder Treatment (CA Bridge): This tool provides step-by-step guidance on how to set up a MAT program in an acute care hospital. Originally implemented in California.
• Hospital Reimbursement (Inpatient Settings): A resource on how to get reimbursed for MAT services in acute inpatient settings
• Hospitalized Patients and OUD Treatment: Discussion of policy and practice to expand opportunities to engage patients with OUDs in opioid agonist treatment during their inpatient hospitalizations.
• Expanding Treatment Opportunities for Hospitalized Patients with Opioid Use Disorders (Winetsky et al. J. Hosp. Med. 2018 January;13(1):62-64.): Discussion of policy and practice to expand opportunities to engage patients with OUDs in opioid agonist treatment during their inpatient hospitalizations.

Substance Use Navigators

• Guide: Hiring a Substance Use Navigator (CA Bridge)
• Substance Use Navigator (SUN) – Frequently Asked Questions (CA Bridge): FAQs on SUN credentials, legal implications, etc.
• Substance Use Navigator (SUN) and Prescriptions – Frequently Asked Questions (CA Bridge): FAQs on SUNs and prescriptions. Includes example scenarios.
• Guide: SUN & Clinician Champion Collaboration (CA Bridge)

Examples of Hospital OUD Programs

• Support for Hospital Opioid Use Treatment (Project SHOUT) (California Health Care Foundation (CHCF)): Project SHOUT helps hospitals start buprenorphine and methadone during ED visits and inpatient hospitalizations.

Guidance

• Treatment of Opioid Use Disorder in Correctional Settings Guideline – June 2020 (American Society of Addiction Medicine (ASAM))
• Treatment in Correctional Settings Toolkit (American Society of Addiction Medicine (ASAM))
• Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings – April 2019 (Substance Abuse and Mental Health Services Administration (SAMSHA))
• Best Practices for Successful Reentry for People Who Have Opioid Addictions – November 2018 (National Re-entry Resource Center)
• Opioid Addiction and the Criminal Justice System Webinars (National Re-entry Resource Center)
• Care for Patients with Opioid Use Disorder Who Are in Custody (CA Bridge)
• Opioid Treatment FAQs (National Commission on Correctional Health Care)

Examples of MAT Programs in Corrections

• Strategies for Connecting Justice-Involved Populations to Substance Use Disorder Treatment (Webinar & Audio) (Medicaid Innovation Accelerator Program (IAP))
  • Webinar
  • Audio
• Opioid Addiction Treatment in Jail (Healthcare Resource Centers (HCRC))
• Opioid Use Disorder Treatment in Jails and Prisons (Pew Trusts)
• Medication-Assisted Treatment in Correctional Settings (California Health Care Foundation (CHCF))
• Safe Withdrawal in Jail Settings Preventing Deaths, Reducing Risk to Counties and States (The Center for Health and Justice is a division of TASC, Inc.)

Homeless

• Recommendations for the Care of Homeless Patients with Opioid Use Disorders (Health Care for the Homeless Clinicians' Network)

Community Resources and Equity

• The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study (Winhusen et al. Drug Alcohol Depend. 2020 Dec 1; 217:108325.): A study spread across four states that tested whether Communities That HEAL (CTH), a community-engaged intervention, can decrease opioid-involved deaths in intervention communities, relative to wait-list communities. The CTH intervention seeks to facilitate widespread implementation of three evidence-based practices (EBPs) with the potential to reduce opioid-involved overdose fatalities: overdose education and naloxone distribution (OEND), effective delivery of medication for opioid use disorder (MOUD), and safer opioid analgesic prescribing. A key challenge was delineating an EBP implementation approach useful for all HCS communities.
• Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States (Centers for Disease Control)
• Medication Assisted Treatment Implementation Checklist (National Council for Behavioral Health (NCBH))
• Building Power and Equity with People Who Use Drugs (National Harm Reduction Coalition)