MAT on the Front Lines: ED Buprenorphine Initiation at a Community Hospital (1.5 CME)

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(1.5 CME) In this conference recording from the 2019 Annual Conference, you will learn:

Introduction: With the high prevalence of untreated opioid use disorder and increase in opioid-related overdoses nationwide, there is a need for innovative programming to increase access to medication-assisted treatment (MAT).  Interest is building in programs that initiate buprenorphine in the Emergency Department (ED) since a recent study demonstrated successful outcomes with this approach  (D’Onofrio, 2015).  We have successfully implemented a rapid-access buprenorphine initiation program in the Emergency Department of a small community hospital in a rural area of Maine.  In this session, we will describe our program, present results 18 months post-implementation, and discuss our successes, challenges and lessons learned. Methods: A multidisciplinary team came together from the ED and the hospital’s outpatient addiction program to create treatment algorithms for communication, screening and clinical care.  We established standing appointments for intake at the outpatient addiction program within 72 hours of ER presentation.  Clinical staff was educated and trained on issues related to buprenorphine management, addiction, and stigma.  We created a system to track patient retention in treatment. Results: Fewer patients accepted buprenorphine in the emergency department than were anticipated.  The program treated approximately 25 individuals in the first year, a small minority of those who qualified.  Those who received buprenorphine in the ED followed up for treatment at the outpatient addiction program the vast majority of the time, and were retained in treatment at rates comparable to the D’Onofrio study and the general treatment-seeking population.  Unexpected challenges and successes rose from our experience, which have led to valuable lessons learned. Conclusion: We expect interest to continue to grow in ED buprenorphine initiation programs.  Implementing such a program in a small, rural hospital is feasible and with outcomes similar to the experience in larger medical centers.  Our experience overall has been highly successful and rewarding, and others stand to benefit from our experiences as they develop programs of their own. 

Learning Objectives:

1.) Define the essential components of an effective ED buprenorphine initiation program.
2.) List several potential benefits and challenges of such programs.
3.) Describe how an effective ED buprenorphine initiation program could be implemented in the participant's healthcare system.

Leah K. Bauer


Leah Bauer, MD is a psychiatrist and Medical Director of the Addiction Resource Center at Mid Coast Hospital in Brunswick, Maine.  She is a Clinical Assistant Professor of Psychiatry at Tufts University School of Medicine, and is board certified in Adult Psychiatry and Addiction Medicine.  Dr. Bauer graduated Alpha Omega Alpha from the University of Cincinnati College of Medicine and went on to residency at the Massachusetts General Hospital and McLean Hospital adult psychiatry program, where she served as administrative chief resident.  In her current role at Mid Coast Hospital, Dr. Bauer leads a team of physicians and behavioral health clinicians, overseeing a robust buprenorphine/naloxone program, intensive outpatient programs, and evaluation and management of co-occurring psychiatric disorders.  She works collaboratively across hospital departments in clinical and administrative capacities and has developed programs including naloxone distribution and integrated care for pregnant and post-partum women.  In October of 2017, her team launched the first Emergency Department buprenorphine initiation program in the state of Maine.  Dr. Bauer has presented on issues relating to innovative delivery of medication assisted treatment for opioid use disorder at local and national levels.  She consults with programs across Northern New England regarding Emergency Department buprenorphine initiation and rapid-access to outpatient treatment.  In addition to her work in addiction medicine, she works as a consulting psychiatrist for Bowdoin College, and enjoys a balanced life in Maine with her family.

Timothy Fox


Dr. Timothy Fox is the Director of Emergency Services, Linconhealth Chair of the EM Workgroup at MaineHealth

Sydney Ford


Sydney is a third year medical student at Tufts University School of Medicine from Brunswick Maine. She received her Bachelor of Arts in International Relations from the University of St. Andrews in Scotland, and her Master of Public Health from Boston University. She returned to Maine to complete a post-baccalaureate at the University of Southern Maine before beginning medical school. She will graduate in 2020 and plans to do a Fellowship in Addiction Medicine following a residency in Ob-Gyn.

ACCME Accredited with Commendation

ACCME Accreditation Statement

The American Society of Addiction Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

AMA Credit Designation Statement

The American Society of Addiction Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s).  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABPM Maintenance of Certification (MOC)

The American Board of Preventive Medicine (ABPM) has approved this activity for a maximum of 1.5 LLSA credits towards ABPM MOC Part II requirements.

ABAM Transitional Maintenance of Certification (tMOC)

This course has been approved by the American Board of Addiction Medicine (ABAM). Physicians enrolled in the ABAM Transitional Maintenance of Certification Program (tMOC) can apply a maximum of 1.5 AMA PRA Category 1 Credit(s)™ for completing this course.

ABIM Maintenance of Certification (MOC)

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn 1.5 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.


Session Recording
Open to view video.
Open to view video. This session was recorded on 4/7/19 in Orlando, FL
CME Quiz
3 Questions  |  10 attempts  |  2/3 points to pass
3 Questions  |  10 attempts  |  2/3 points to pass Complete the quiz to claim CME.
CME Evaluation
15 Questions
15 Questions Please complete the evaluation to claim CME.
CME Credit and Certificate
Up to 1.50 medical credits available  |  Certificate available
Up to 1.50 medical credits available  |  Certificate available 1.5 AMA PRA Category 1 Credits