Dr. Michael Lynch, medical director at the Pittsburgh Poison Center and substance use disorder services at UPMC Health Plan, has made medication-assisted treatment (MAT) a focus of his for the last few years while working in the emergency department at UPMC Mercy.
As an ED physician, Lynch works directly with patients who have a history, or are at-risk, of opioid dependence. Although safety and quality prevention measures have been in the spotlight when publicly discussing opioid use disorder, Lynch’s attention has focused on developing a more proactive treatment process for at-risk hospital patients.
“I realized as I was seeing more and more of these patients, as we all have over the last couple of decades, that the services that we were providing really weren’t adequately addressing their needs and I felt like we could be doing a lot more,” he said. “Not only for safety and prevention, but also to improve treatment for them in the emergency department, in the hospital, and getting them to good and effective outpatient treatments.”
Clinician Collaboration: An Antidote for Success
To maintain his goal and emphasize quality and safety, Lynch expanded the pioneering work of Dr. Mike Turturro, ED chief, and Andrea Sargent, director of pharmacy at UPMC Mercy, who initiated an opioid-focused program in the ED.
Naloxone®, more commonly known as Narcan, is an emergency medication that reverses opioid effects, and can save the life of the patient during an overdose situation. This medication, administered as a nasal spray, does not require a prescription, and is given directly to patients considered high-risk. Lynch collaborated with different UPMC Mercy ED teams to introduce and standardize the practice systemwide.
Lynch said that more than 80% of patients who receive this take-home, emergency medication say they would not have otherwise gotten their prescription filled if the hospital had not done it for them.
Since the start of this practice, 17 EDs have given out more than 1,000 Narcan kits within the first 18 months of inception. UPMC Mercy’s ED has distributed 514 in the first 21 months of the program.
Lynch has also seen success in patients who start MAT for their opioid dependence prior to discharge.
Using the prescription Suboxone® under physician supervision helps wean sufferers off illicit opioid use.
“Starting Suboxone® therapy is critical to addressing individuals who have opioid use disorder,” he said. “Starting sufferers on Suboxone® while they’re in the hospital increases the treatment’s success.
How to Remedy the Stigma
The opioid epidemic is sweeping and does not discriminate.
“It cuts across all cultural and socio-economical divides,” Lynch said. “We see it in all of our patient populations, whether it’s urban, suburban, rural, affluent, poor, homeless, up to the wealthiest patients.”
In light of this, providing quality, safe and easy to access treatment for sufferers is of the utmost importance. By providing effective resources during a patient’s stay, it increases the chance that individuals will seek help after discharge.
By normalizing opioid use treatment, it “doesn’t place undue burden that we wouldn’t expect people with other types of diseases to have to overcome,” Lynch added. “We have to be more thoughtful about what we’re treating and how we’re treating it.”
Understanding that opioid use disorder is a disease catalyzed by factors such as genetics and the environment, is critical to comprehensive patient care. Every employee that is involved in an ED patient’s stay, from physicians and nurses, to the admissions personnel, plays a role in the success of the patient during and after their stay. Being aware about the language we use when talking to or about sufferers is critical.
“There is a person who has an opioid use disorder, a person who has alcohol use disorder,” Lynch said. “Recognizing these individuals as human beings with thoughts and feelings and a lot of experience that has been traumatic and hurtful and family members who care and love them and who have been devastated as well by this, and just trying to take a step back and remember, those are the kinds of things that will help us address the stigma attached with it.”