For the last two decades, almost all patients brought into a Western New York emergency room after an opioid drug overdose were stabilized, given a short list of treatment clinics to call for a follow-up appointment, and then released.
The results were predictable. Few appointments were scheduled, and the potentially fatal cycle of drug addiction continued.
That began to change two years ago, when Dr. Joshua Lynch went on a regionwide crusade to bring together those on the front lines of the opioid crisis.
Health care providers in 17 ERs now treat those suffering from an overdose, or in withdrawal, on a short course of appropriate medication, then provide them the chance to make a guaranteed appointment – within two days – at one 47 drug treatment clinics across the region.
The process has shown such promise that the state Department of Health will announce on Wednesday that it will launch the Buffalo Medication Assisted Treatment and Emergency Referrals, or Buffalo MATTERS, program across New York.
“If somebody comes in with chest pain, we would never just blow them off and send them home," Lynch said. "That’s what we used do that for patients with opioid-use disorder. I think we’ve wholeheartedly now realized in the medical community that this is a potentially life-threatening chronic disease."
Lynch brings an overarching perspective to the opioid crisis, which claimed the lives of 301 people in Erie County three years ago, 251 people a year later – when he and other emergency room doctors started a pilot ER treatment program – and 191 confirmed deaths last year as more health care providers joined the effort.
He was volunteer firefighter and paramedic in the decade before he became an emergency room doctor in 2008, and once worked with Mercy Flight, a helicopter emergency transport company.
During the height of the crisis in Erie County, Lynch and others decided there had to be a better way to help those with opioid-use disorder, and their loved ones, maneuver a medical and treatment system that can be daunting, judgmental and overwhelmed.
“We've tried to remove a lot of the barriers that patients have encountered in the past,” he said.
The Buffalo MATTERS program was developed by Lynch and others in the Department of Medicine at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.
Participating emergency department providers have used the program to help about 150 patients start drug-assisted treatment and book appointments before leaving the hospital.
This used to be where the bottleneck to treatment started just a few years ago.
“The real problem was within the referral process, which was pretty simple and not effective,” said Lynch, a clinical assistant professor of emergency medicine at the Jacobs School and physician with UBMD Emergency Medicine. “We would basically give the patient a list of phone numbers to call to try to get into rehab. After we really started to focus on how these patients were doing, we realized that some of the numbers on this list didn't even work and the patients were not going to call to make an appointment.”
This approach also led patients and their loved ones to believe a severe shortage of treatment beds existed in the region – even though dozens were being added to address the opiate crisis – and that an inpatient detox program at Erie County Medical Center was one of very few options, Lynch said.
As outpatient treatment programs grew to meet demand, the next obstacles became regulations and competition, the ER doctor said.
Clinical programs required clients to go to three or four clinic appointments over several weeks before prescribing suboxone (also known as buprenorphine) or methadone – two drugs that block the euphoric sensation of opiates and help ease withdrawal symptoms, lightening the path toward recovery.
Those programs all tend to use their own medical records and appointment systems, as well as treatment standards, Lynch said.
He and other Buffalo MATTERS leaders encouraged a growing number of those providers to take a more collaborative approach to help save lives.
It is possible for those without an opioid-use disorder to get high on methadone and buprenorphine (also known as suboxone), but dosages provided in emergency settings and treatment clinics have a different impact on those with a high tolerance to opiates, blocking the euphoric effect while tamping down what often are debilitating withdrawal symptoms best managed over months or years.
The refrain “we just don’t do that here” became less common, Lynch said, as he and others on board were able to share research from other communities that showed those who start medication-assisted treatment in emergency rooms and are scheduled right away for treatment appointments tend to stay engaged in treatment longer and are less likely to return to opioid abuse.
Dr. Gale Burstein, Erie County health commissioner, said emergency medicine doctors in other communities who helped prove this were outliers, generally running small efforts that involved one hospital emergency room and a small number of patients.
Lynch and others with UBMD Emergency Medicine deserve credit for the persistence they’ve shown in bringing the approach to a whole region, Burstein said.
There also have been other obstacles. People without health insurance or with other substance-use disorders – addictions to benzodiazepines like Xanax, for instance – also posed a challenge for clinics with policies that denied treatment for such patients.
Lynch and his team convinced those clinics to waive such policies – and agree to provide long-term treatment – in exchange for participation in Buffalo MATTERS.
The John R. Oishei Foundation gave initial funding for the pilot program in 2017, the Blue Fund of BlueCross BlueShield of Western New York provided $200,000 to boost the program last year, and now the state health department stands ready to help.
Mercy Flight handled treatment appointment scheduling at first. This month, the state health department set up a new online platform that participants can be accessed on an iPad. Hospitals in Western New York already are linked, with those from Albany and New York City next to follow. Patients across the state can get a better understanding about how the program works by visiting buffalomatters.org.
Patients at participating ERs who arrive at the hospital because of an overdose or opioid withdrawal will be encouraged to sign on for treatment and, if appropriate, be given a course of suboxone to last up to seven days. Those patients will provide basic information, including where they live and their drug and medical histories.
Then a listing of appointments available during the next 48 hours will pop up on a computer screen. Generally, about 100 appointments scattered across Western New York pop up, Lynch said.
“We also through the website have an automatic linkage to peers to help talk patients through the first couple days,” he said.
Another route toward help is the Erie County Addiction Hotline, 831-7007.
“We want to try to make as many options as possible for people to access care,” Burstein said, “because this is lifesaving treatment, just like treatment of any chronic disease.”
The UB departments of emergency medicine and family medicine, and the university's Primary Care Research Institute, will spend the next several months examining how the program is working. They already know that at least half of patients seen through Buffalo MATTERS followed through with early appointments.
“The law enforcement community, the medical community, the government, counselors, peers and first responders have all chipped in,” Lynch said, “and none of these groups can work alone. This is all of us working together and it’s partially what contributes to the reduction of death.”
Article originally appeared in The Buffalo News on July 24, 2019 by Scott Scanlon, an award-winning reporter and editor of WNY Refresh, which focuses on health, fitness, nutrition and family matters.