- The Washington Times - Monday, May 7, 2018

D.C. officials plan to administer medications that help with addiction recovery to emergency room patients in the effort to combat the opioid epidemic.

The pilot program for the ER procedure will skirt federal requirements that doctors hold extra certifications to dispense opioid treatment medications, such as buprenorphine.

“We have this actual restriction associated with buprenorphine, in that clinicians have to be certified by the Substance Abuse and Mental Services Administration to be able to treat someone with buprenorphine,” said Michael Kharfen, senior deputy director of the D.C. Department of Health’s program to combat HIV/AIDS, hepatitis, sexually transmitted diseases and tuberculosis.

The city’s health department has funded some doctors at clinics such as Whitman-Walker Health to complete such training, but certification requires time and money that the District can’t afford in the fight against opioid addiction, Mr. Kharfen told The Washington Times.

ER doctors don’t need to be certified to administer a three-day dose of the medication as part of emergency care, which means opioid-addicted patients who enter emergency rooms can start recovery treatment immediately, he said.

What’s more, Mr. Kharfen said, the pilot program aims to fund area hospitals to dispense medication-assisted treatment such as buprenorphine, if ER patients want it, and then connect them with primary care providers who can continue administering the medications and offer other services.

Jacqueline Bowens, CEO of the D.C. Hospital Association, which represents at least 10 medical facilities in the District, said member hospitals are eager to join the program and treat people with addictions.

“We address their overdose, but if they don’t have a place to sleep or they can’t afford their medication, we want to connect them to get those things the hospital can’t provide,” Ms. Bowens told The Times.

She said a “warm handoff” between hospitals and community care providers also would benefit emergency departments, which sometimes struggle with patients with addictions who don’t know where to go after treatment or return frequently for emergency care.

“A lot of these patients go from ER to ER,” Ms. Bowens said. “One of the indicators of the success of this program will be to what degree did we decrease that as an issue.”

“This could be disastrous if we’re not coordinated between the hospitals and the community,” said Sharon Hunt, director of Specialty Care Division of the D.C. Department of Behavioral Health.

A social worker by training, Ms. Hunt said she is looking at ways to facilitate community service partnerships by training navigators to connect patients with primary care providers and services, and peers — those recovering from addictions who can mentor other patients. She is looking closely at Baltimore and New Haven, Connecticut, which have implemented versions of the pilot treatment.

The District is one of the few places in the country where the epidemic doesn’t skew toward young white men whose addictions start with prescribed painkillers. The D.C. Policy Center reports that most opioid overdoses in the city happen to older black men who are longtime heroin users. They face a high risk of overdose from synthetic opioids such as fentanyl, which medical professionals say is 50 to 100 times more powerful than heroin.

“It’s our fathers and our grandfathers, it’s our uncle that are dying,” Dr. Roger Mitchell, the city’s chief medical examiner, told The Times. “That’s maybe not as visceral as the 20-year-old white kid from the suburbs, but for us, that’s our population that’s being affected.”

According to the Office of the D.C. Chief Medical Examiner, 279 people died of opioid-related causes last year, establishing the District as one of the U.S. cities with the highest per-capita death rates, outside the opioid crisis epicenters in West Virginia and New Hampshire. The District’s opioid death toll has climbed from 231 in 2016 and 114 in 2015.

Mr. Kharfen, who has managed the city’s needle exchange program, said surveys of drug users in the District found that they desperately want to kick their addictions with the help of medications such as buprenorphine — an opioid that is used for detoxification, to ease withdrawal symptoms and as a replacement for other opioids such as heroin and fentanyl.

However, none of the officials who spoke with The Times was able to provide a cost estimate for the pilot program.

“It really depends on what model we pick and how it works within the hospital,” said Ms. Hunt, whose department received a two-year, $2 million dollar federal grant in 2016 to fund more medication-assisted treatment in the District.

• Julia Airey can be reached at jairey@washingtontimes.com.

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