Medication for Addiction and Treatment (MAT) in the Emergency Department-Medication for Addiction and Treatment (MAT) in the Emergency Department

Video Transcription

Video Summary

Shannon Koenig and John Bresson, experienced nurse practitioners in emergency departments, discuss Medication for Addiction Treatment (MAT), focusing on buprenorphine for opioid use disorder (OUD) in emergency settings. They emphasize the growing opioid crisis worsened during the COVID-19 pandemic, with overdose deaths reaching around 100,000 annually in the U.S. They stress substance use disorder as a chronic medical condition requiring evidence-based treatment rather than stigma or detox alone.<br /><br />Buprenorphine is highlighted as a first-line, safe, and effective MAT that reduces cravings, withdrawal symptoms, and mortality. The California Bridge program promotes 24/7 access to MAT statewide, emphasizing low-barrier treatment, harm reduction, patient-first language, and community partnerships. Emergency departments serve as crucial access points to initiate treatment given their constant availability.<br /><br />John details buprenorphine’s pharmacology, dosing protocols for starting treatment in the ED, and management of precipitated withdrawal. He notes that initiating buprenorphine in the ED improves treatment retention and decreases opioid use. Providers do not need an X waiver to start buprenorphine in the ED but must obtain one to prescribe on discharge; obtaining the waiver is now streamlined. They also discuss reimbursement for MAT services and advocate for clinicians to lead cultural changes in emergency care that treat OUD like other chronic diseases, promoting dignity and evidence-based care.

Keywords

Medication for Addiction Treatment

buprenorphine

opioid use disorder

emergency departments

opioid crisis

X waiver

California Bridge program

person-first language

Emergency Department

Substance Use Disorder

Precipitated Withdrawal