In the fight against the opioid crisis, a new weapon has been deployed in Washington state. Launched last week, the ScalaNW program aims to equip emergency room (ER) clinicians with the tools they need to initiate medication-assisted treatment (MAT) for opioid use disorder (MOUD). This critical bridge between ER care and long-term treatment options holds the potential to save lives and disrupt the devastating cycle of addiction.
The urgency of the situation is undeniable. Between 2019 and 2021 alone, the number of Washington residents who died of opioid overdoses doubled. Despite the proven effectiveness of medications like methadone and buprenorphine in reducing overdose death risk by half, these life-saving interventions remain vastly underutilized. Nationwide, less than 9% of ER visits for suspected opioid overdose result in a MOUD prescription.
This underutilization stems from several factors. Historically, a major barrier was the requirement for clinicians to complete special training to prescribe buprenorphine. This hurdle was thankfully lifted by the Drug Enforcement Administration (DEA) in late 2022. However, the lack of standardized treatment protocols and the logistical challenges of connecting patients with ongoing care continue to impede broader MOUD access.
ScalaNW, funded by opioid settlement and abatement funds, addresses these challenges head-on. The program, spearheaded by the Washington State Health Care Authority (HCA), aims to bridge the gap between the ER and outpatient care by providing clinicians with a comprehensive support system.
ScalaNW’s online hub offers a wealth of evidence-based resources, including protocols for determining the appropriate time and method for MOUD initiation. Recognizing the crucial need for ongoing support, the program facilitates connections with the University of Washington Psychiatry Consultation Line, offering 24/7 access to live clinical expertise.
Another vital component is facilitating access to ongoing treatment. Through the Washington Recovery Helpline, ScalaNW assists in scheduling follow-up appointments at community clinics before a patient’s discharge from the ER. This streamlined process eliminates the arduous task of patients independently securing appointments while potentially still experiencing withdrawal symptoms.
Building upon the success of existing programs like California’s Bridge and New York’s MATTERS, ScalaNW prioritizes collaboration. The program actively solicits feedback from hospital clinicians, clinics, and professional organizations to ensure its effectiveness.
Addressing another barrier, ScalaNW acknowledges the lack of convenient options for methadone, a medication used for opioid withdrawal management. While federal regulations allow hospitals to initiate low-dose methadone for withdrawal, this typically isn’t sufficient for adequate symptom relief. Additionally, hospitals must refer patients to an opioid treatment program (OTP) within a short timeframe. These OTPs, the only facilities legally authorized to dispense methadone for ongoing treatment, are often inconveniently located and pose logistical burdens for patients in crisis.
ScalaNW seeks to address the hesitation some hospitals have about prescribing MOUD. Part of this hesitancy stems from a lack of experience, particularly concerning the support systems traditionally absent in ER settings. With ScalaNW, emergency departments gain access to real-time consultation through the UW Psychiatry line, a critical tool for addressing clinical questions around MOUD initiation and management. Additionally, the program tackles the challenge of scheduling follow-up appointments outside of regular business hours. Through the streamlined referral process, appointments at community clinics can now be made within minutes, regardless of the time of day.
While ScalaNW streamlines the MOUD initiation and referral process, it recognizes that patient readiness is also essential. The program acknowledges that not all individuals who present at the ER will be prepared to begin MOUD. However, ScalaNW equips clinicians with resources to engage patients in conversations about treatment options and offer support in their decision-making.
The initial rollout of ScalaNW will begin with a select group of hospitals that enrolled in August. Currently, the program boasts 15 enrolled sites encompassing hospitals and EMS agencies. Additionally, HCA has reported a strong response from clinics eager to participate in the network.
The launch of ScalaNW marks a significant step forward in Washington’s fight against the opioid crisis. By facilitating access to MOUD in ER settings and streamlining the transition to ongoing treatment, the program has the potential to save lives and offer a pathway to recovery for countless individuals struggling with opioid use disorder.
