WA health officials turn to emergency rooms in fight against opioid epidemic

Washington health officials on Monday announced a new program to help emergency room clinicians prescribe medications to treat opioid addiction.

ScalaNW, a state Health Care Authority program, will offer 24/7 live clinical support to hospitals and emergency rooms looking to provide patients with medications for opioid-use disorder.

The authority is hoping ScalaNW will help physicians feel more comfortable prescribing medications like buprenorphine and methadone, which have been found to significantly cut death rates for patients with opioid addiction.

Most people in Washington at high risk for overdose death have been to an ER within the past 12 months, noted Liz Wolkin, program manager at the Health Care Authority. “So we know that patients who could benefit are there,” Wolkin said.

“The intention isn’t to send people there to get treatment, but to recognize people who could benefit from it,” Wolkin added.

Hospitals that enroll in the hotline, which is offered in partnership with the University of Washington Psychiatry Consultation Line, will also have access to 24/7 follow-up appointment scheduling, supported by the Washington Recovery Helpline and offered to patients before they’re discharged from the emergency room.

For all hospitals across the state — not just those enrolled in the helplines — ScalaNW’s website, ScalaNW.org, will provide clinicians with “evidence-backed protocols to determine how and when” to provide medications for opioid-use disorder.

About 14 hospitals across the state are moving forward with enrollment so far, Wolkin said, in both populous counties like Pierce and King, as well as rural counties where the epidemic has hit hard, like Okanagan. ScalaNW will be funded using about $970,000 in state opioid settlement funds allocated to the Health Care Authority during the 2023-2025 budget cycle.

“The goal of ScalaNW is to really be a centralized and statewide resource, instead of each county or each hospital having to put together the staff and the funding and the resources to develop a program like this at their site,” Wolkin said.

Research suggests less than 9% of overdose-related emergency room visits result in a prescription for opioid-use disorder, despite the fact that an analysis of King County’s emergency rooms found that patients are much more likely to die of a subsequent overdose within 30 days after being treated for one in the hospital.

The reluctance comes from a history of strict federal regulations on opioid-use treatment medications, said Dr. Chris Buresh, an emergency room doctor at Seattle Children’s and associate professor of emergency medicine at the University of Washington. Prescribing buprenorphine used to require additional training, and methadone is still highly regulated.

“It just made the medicine seem somehow like it’s more dangerous,” Buresh said. “There’s no other medication out there like that. I can prescribe medications that are lethal without any additional training.”

Both medications — particularly buprenorphine — are “super safe” for adults, Buresh said, adding that almost nothing is more dangerous than allowing someone to continue to use fentanyl.

“People who use drugs are just like you and me and everybody else. They’re people, and they deserve the very best care that we can provide,” Buresh said. “That’s what these medicines are. And that’s what this website does.”

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