Emergency physicians see their share of patients who end up in trouble because of opioid use. But those doctors say there are obstacles to providing patients optimal care in the emergency department.
To better treat patients for opioid use disorder, the American College of Emergency Physicians (ACEP) urged policymakers to take three specific steps that would remove obstacles to care. The national medical society that represents emergency medicine physicians spoke out as the Department of Health and Human Services (HHS) compiles a report to Congress on treating opioid use disorder.
ACEP called for the following actions:
For Congress to remove the waiver required for physicians to prescribe buprenorphine, a medication that can help people quit the use of heroin or opioid painkillers. Emergency physicians see strong results when they can use buprenorphine as part of medication-assisted treatment (MAT) for patients with opioid use disorder, the group said. “Initiating MAT in the emergency department closes gaps in treatment and helps individuals stay in treatment longer, reduces illicit opioid use and infectious disease transmission and decreases overdose deaths,” ACEP said.
However, to prescribe buprenorphine, doctors must have a waiver that requires them to complete an eight-hour course and license application. It can take 60 to 90 days for physicians to receive the waiver from the Drug Enforcement Administration. ACEP said the waiver requirement has created a misperception that buprenorphine is different from other medications, so some physicians have been less willing to pursue the waiver or engage in treatment of patients with opioid use disorder at all. In some cases, there is not an adequate supply of buprenorphine in the emergency department or hospital pharmacy because of the confusion surrounding the waiver, the group said.
For regulators to modify the “three-day rule.” This federal regulation requires administration of buprenorphine one day at a time and makes patients return to the emergency department or other care settings to receive treatment. Emergency department physicians should be able to dispense a three-day supply of buprenorphine or administer a dose that will last three days, the group said.
For insurers to remove pre-authorization requirements. In most states, there is a pre-authorization approval requirement by insurers to prescribe buprenorphine. That creates a problem as it is estimated that only 25% of emergency patients visit during typical office hours. Some states have removed prior authorization for buprenorphine for patients on Medicaid, but the requirement persists in most states for most insurers.
The group also said it supports steps to improve prescription drug monitoring program reporting so that fragmented state-level prescribing data can be reported at the federal level.