Emergency departments connecting more people to opioid treatment

Having Suboxone available in EDs has decreased barriers to accessing OAT - particularly in communities where there are a limited number of health-care professionals prescribing OAT and it's difficult for a client to get treatment - by providing front-line nurses and physicians with the necessary training to prescribe the treatment, and by helping educate patients on how to start it themselves at home. 

“The opioid crisis continues to impact patients, families, and communities. We can be part of the solution to the toxic drug crisis and hopefully prevent lives from being lost by providing OAT in the ED,” says Heather Hair, IH’s Emergency Services network director.

“Frontline health-care workers in emergency departments often see first-hand the impacts of addiction and overdose. We are having conversations and building relationships with people who often have experienced stigma, and hopefully helping keep them from harm.”

Given the increasing number of toxic drug deaths across B.C. – deaths that reached a tragic 2,224 in 2021 – Interior Health’s Emergency Services and Mental Health and Substance Use networks partnered in June 2021 on a strategy to introduce a standardized approach for connecting people with opioid use disorder to Suboxone in emergency departments. The project includes making available Suboxone To-Go Packs that people can use to get started at home, and a new urgent referral process to connect people to ongoing OAT in the community. 

The Suboxone in the ED project has now been implemented at 20 hospitals across Interior Health, most recently in the South Okanagan in April, which resulted in a celebration of the enrolment of the 100th client in the program. This month, Suboxone in the ED will also be introduced in the Kootenay Boundary.

Throughout the project’s phased implementation, feedback from both clinicians and patients has been overwhelmingly positive. 

Nurse Prescriber Laura Sherret, who works in Cranbrook, says when she first heard about the plan to implement Suboxone in the ED at East Kootenay Regional Hospital, she was excited – especially because access to OAT was otherwise fairly limited in the community. Since then, the program has surpassed her expectations. 

“The clients I have seen as a Nurse Prescriber who have succeeded in staying on Suboxone or transitioned to the long-acting injectable are doing very well,” says Laura. “They are reconnected to families, have jobs, and are managing life’s challenges in positive ways. Others have gone on to other OAT therapies that suit them better so they, too, can move forward. We continue to build relationships and trust with others and support them in their choices.”

Laura also says she has seen an “amazing shift” in the ED staff she works with, because they have a better understanding of what Suboxone is and how it works.

“They have a resource at their fingertips to help patients with opioid use disorder,” she says. “They can initiate Suboxone in the ED if the person is in sufficient withdrawal, or discharge the person with a To-Go Pack to start at home. The relative safety of Suboxone and its ability to relieve withdrawal symptoms quickly makes it a good option for people who live with opioid use disorder.

“It is now considered the gold standard of care, and that care is being provided right here in the ED at East Kootenay Regional Hospital.”