Hospitals in Massachusetts have implemented a plan that instructs emergency providers to develop an approach to screen for substance abuse, provide brief intervention, and arrange appropriate referrals for patients who have an active substance use disorder or are at risk for developing such a problem. The nine-point plan, which is outlined on the website of the Massachusetts Hospital Association (MHA, www.mhalink.org), also calls on physicians to consult the state’s prescription monitoring program before prescribing an opioid, and to use health information exchange systems to share ED visit histories with other emergency providers. Other points in the plan call on EDs to:
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coordinate care processes for patients who frequent the ED with substance use issues;
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notify a patient’s primary care provider or primary opioid prescriber following an ED visit for acute exacerbations of chronic pain;
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refrain from replacing prescriptions for controlled substances that patients report have been lost, stolen, or destroyed;
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refrain from prescribing long-acting or controlled-release opioids;
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mandate patient counseling on the proper usage, storage, and disposal of opioids when prescribed by an emergency provider;
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limit prescriptions of opioid analgesics to no more than a 5-day supply to patients who present with acute pain.
The plan, which was developed by a substance abuse disorder and treatment task force of the MHA, is intended to standardize opioid prescribing by emergency providers across the state, although developers stipulate that the recommendations should not interfere with a treating physician’s judgement in deciding what course of treatment is best for an individual patient. All 51 MHA-member hospitals in the state have pledged to put the recommendations into practice in their EDs, and future plans call for extending the plan to hospital outpatient settings and eventually to private medical practices in the state as well.
