With drug-related deaths on the rise, researchers at the Yale School of Medicine have made important strides in treatment for opioid users — and been recognized for their achievements.
The research, published first online in the British Medical Journal in October 2015, won the Dan Anderson Research Award on Feb. 10, an award sponsored by the Hazelden Betty Ford Foundation’s Butler Center for Research that honors scientific research about addiction recovery. The study authors will accept the award and a $2,000 honorarium from the foundation later this year. Working with patients who arrived at the emergency department, physicians administered one of three treatments: brief substance abuse screening and referral to treatment, a 10 to 15 minute intervention and referral to treatment or a brief intervention, referral to treatment and buprenorphine, a prescription medication used to treat opiate addiction. Their work showed that the third group demonstrated remarkably reduced opiate intake, and that participants were more likely to be continuing treatment during a follow-up.
“[Researchers] anticipated that this type of referral, combined with medical treatment that addressed the patients’ withdrawal symptoms, would lead to greater success than a standard referral,” David Fiellin, study co-author and medical school professor, said.
Their work comes at an important time: Opioid use has risen nationwide, according to the Centers for Disease Control and Prevention. Gail D’Onofrio, study co-author and chair of the Department of Emergency Medicine at the medical school, said that opiate use is an “epidemic” and that overdoses are continuing to rise. Many addicts’ first medical contact occurs in emergency department situations, she said, and health providers have a unique opportunity to identify opiate-dependent persons and provide treatment. First responders in the emergency room are one of the only lines of defense in initiating addiction treatment.
Even though opiate addiction is also a chronic brain disease, in that it is characterized by changes in brain chemistry and structure, opiate-dependent people often leave the emergency department within a few hours of waking up, D’Onofrio said. In contrast, many other patients with chronic diseases, such as diabetes or heart disease, are referred to relevant care providers during their visit to an emergency department.
Fiellin noted that their research model had a few essential features, including an emergency medicine physician who could diagnose opioid-use disorder, prescribe buprenorphine and naloxone — a medication used to reverse the effects of opioid overdose — and arrange a follow-up session with the patient. The treatment program would need to be able to accept the patient within two to three days of the emergency department visit, he added.
Aubrey Klein, executive director of the Butler Center, said that the paper was “chosen for [the award because of] its strong methodology and scientific rigor, as well as the topical nature of the study.” She added that the study targets an important group of opioid users — those seeking treatment in emergency departments.
The study’s findings point to more rigorous emergency department interventions as a means to reduce the impact of opioid use for both users themselves and for the wider health care system, according to the paper. Fiellin said that the researchers are working with the National Institutes of Health to design a larger-scale study in multiple emergency departments around the country. A number of emergency departments have already contacted the researchers with inquiries about replicating their model, he added.
According to the CDC, the rate of deaths from drug overdoses has increased 137 percent since 2000, including a 200 percent increase in the rate of overdose deaths involving opioids.