Helping emergency clinicians treat opioid-use disorder

Washington state has launched a new website to help emergency department  clinicians start opioid users on treatment at the time of their visit.

The website, called ScalaNW, provides clinicians guidance on how to prescribe drugs such as buprenorphine and methadone. These drugs suppress withdrawal symptoms, reduce the craving for opioids and blunt opioids’ euphoric effects, discouraging their use. 

Treatment with these medications have been shown to cut overdose death rates by half.

The website’s name, which is derived from the Latin word for “staircase” or “ladder,” was chosen to reflect the patient's journey in overcoming substance abuse disorder and the support the initiative provides them during the journey.

The initiative is the result of a partnership between the Washington State Health Care Authority (HCA), the University of Washington School of Medicine’s Department of Emergency Medicine, Department of Psychiatry and Behavioral Sciences, and the Addictions, Drug & Alcohol Institute.

“The Emergency Department is a critical place to deliver medications for opioid use disorder, since it can be the first and sometimes the only place where people with opioid use disorder connect with medical care,” said Dr. Charissa Fotinos, the Health Care Authority’s medical director. “Our goal is to give ER clinicians the support they need to administer lifesaving medication for patients in need of care.” 

The website will provide all Washington hospitals with access to protocols and guidelines to help determine how best to treat individual patients. Clinical consultation will be available 24/7 from the UW Medicine Psychiatry Consultation Line. Staff will also be able to schedule follow-up appointments for patients before they leave the Emergency Department. The website will also provide guidance on ways to reduce their risk of overdose and how to obtain treatment.

“ScalaNW delivers what ED clinicians need to confidently assess and treat people with opioid use disorder: evidence-backed, accessible information to quickly guide treatment,” said Dr. Chris Buresh, an emergency medicine physician, who helped develop protocols for ScalaNW. “I’m confident that the tools offered through ScalaNW will help get these important medications to those who need them.”

Many clinicians are reluctant to use drugs like buprenorphine because, until recently, special training was required to prescribe them. These requirements were lifted in 2022, but many clinicians remain unfamiliar with its use and reluctant to prescribe it.

“I don’t think that message that there’s no more special training got out as widely as it could have,” said Buresh. “I think people are still left with the impression that this medication is complicated or dangerous.”

Written by Michael McCarthy

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