Opioid Treatment Program Developed at UB Expanding

The Buffalo Medication Assisted Treatment & Emergency Referrals (Buffalo MATTERS) program is currently available through the emergency departments of 17 hospitals — including all Kaleida Health, Catholic Health and Erie County Medical Center facilities and several other community hospitals — throughout the eight counties of Western New York. This was made possible by a $200,000 award from the Blue Fund of BlueCross BlueShield of Western New York in 2018. 

It provides medication-assisted treatment (MAT) to opioid use disorder patients in emergency departments and rapidly transitions them into long-term treatment at a community clinic of their own choosing — all within about 24 to 48 hours.

Approximately 150 patients have been referred from local emergency departments through Buffalo MATTERS. The program is believed to be one of several factors contributing to the decline in opioid-related deaths in Erie County, with 186 deaths confirmed in 2018, compared to 251 in 2017 and 301 in 2016.

Support from the New York State Department of Health (NYSDOH) will allow the program to expand across New York State and increase the utilization of buprenorphine in the emergency department.

In the next six to 12 months, it is anticipated that the MATTERS concept will be implemented in hospitals in the greater Albany and mid-Hudson regions along with hospitals and clinics in the New York City area.

The program’s founder, Joshua J. Lynch, DO, clinical assistant professor of emergency medicine and a physician with UBMD Emergency Medicine, has been serving as a technical adviser to the NYSDOH.

According to the NYSDOH, settings such as emergency departments are on the front line of the opioid crisis and can serve as a crucial point of engagement for people with opioid use disorder. NYSDOH has recognized this and has made significant efforts to support the continued integration of buprenorphine in emergency departments across New York State.

Additional support from the NYSDOH has led to new developments within the MATTERS program, including an online electronic referral system that will be housed on a secure communications system operated by the department.

The online referral system will streamline referrals to community-based MAT providers and allow them to provide ongoing care for those initiated on MAT in the emergency department setting. This online system will support access to resources for providers and provide an opportunity to capture robust outcomes data to evaluate the effectiveness of the program.

“Through the emergency departments of Western New York hospitals, Buffalo MATTERS has been changing — and saving — the lives of patients suffering from opioid use disorder,” says Nancy H. Nielsen, MD, PhD, senior associate dean for health policy, clinical professor of medicine and a member of the Erie County Opiate Epidemic Task Force.  

“These patients arrive at our emergency departments, many in desperate circumstances, often as a last resort. This funding from the New York State Department of Health will bring the successes that we are starting to see in Western New York to all of the regions of our state and, we hope, beyond,” she adds.

The program began in 2015, as UB physicians were trying to find a better way to treat patients who came to local emergency departments in withdrawal.

“We needed to be able to help control their symptoms and quickly transition them to community clinics,” Lynch recalls. “We knew we weren’t doing a great job on either one, but there weren’t many good alternatives out there.”

Lynch and his colleagues began studying methods implemented by physicians at Yale University, who found that patients going through withdrawal who were given the opioid treatment buprenorphine in the emergency department and then provided with a clinic appointment were more likely to still be in treatment a month later and to have reduced their opioid use.

“When we saw that, we wanted to do it here,” Lynch says.

He began to encourage colleagues to undergo the training that providers need to administer buprenorphine, a controlled substance. After providers got the training, Lynch and his colleagues developed a standardized approach for evaluating and managing patients.

A member of the Erie County Opiate Epidemic Task Force, Lynch then began approaching clinic directors to see if they would agree to see a few patients each week who had started buprenorphine in the emergency department either at Buffalo General Medical Center or Millard Fillmore Suburban Hospital. Both are teaching hospital partners of the Jacobs School and part of Kaleida Health.

Currently, 47 Western New York clinics provide more than 120 appointment slots each week exclusively to treat opioid use disorder patients, usually within 24 to 48 hours of being discharged.

And patients are responding.

“The patient in withdrawal who drives to the emergency room because they know they need help is looking for a way to get better,” Lynch says.

“As emergency medicine physicians, we are on the front line of this epidemic,” he adds. “Buffalo MATTERS developed out of the critical need to address the opioid epidemic as we saw it unfolding in our emergency departments of the hospitals of Buffalo and Western New York, just as our colleagues across the state and the country are also seeing it.”

“Thanks to Buffalo MATTERS, these patients can now leave the emergency department not only with buprenorphine in hand for their symptoms, but also a treatment plan and a convenient follow-up clinic appointment within 48 hours, usually in their own neighborhood. There’s probably nothing that says more powerfully to them, ‘your community is here for you and we want to help you.’” 

The program’s success has also attracted significant attention from private foundations. The John R. Oishei Foundation initially funded it in 2017 as a pilot project.

More recently, new donations are allowing the program to provide support for addiction treatment medications if patients lack insurance and cannot pay out of pocket. Buffalo MATTERS now includes a voucher program that provides assistance for purchasing medication. Praxair provided initial funding for the startup of the voucher program.

In addition to Lynch, the Buffalo MATTERS team includes:

• Brian Clemency, DO, associate professor of emergency medicine and director of research and external funding for the program
• Johanna C. Innes, MD, clinical assistant professor of emergency medicine and the program’s director of medical specialty outreach

All three are physicians with UBMD Emergency Medicine.

Lynch and Clemency have been contacted by cities throughout New York State and beyond; they have begun working with cities abroad that they came into contact with as a result of the Fulbright Program on opioid use at UB this spring. Lynch traveled to Sydney, Australia, to present the MATTERS concept to an international audience.  

They are also working to make the program available in jails to people who have been arrested and through obstetrics and gynecology offices to treat pregnant women who are opioid users.

Buffalo MATTERS is one of a number of multidisciplinary UB initiatives — involving faculty from the Clinical and Research Institute on Addictions (CRIA) — that aim to address the crisis of substance use disorders by reducing addiction incidence, improving addictions care and finding new ways to prevent and treat addiction. Lynch is the co-chair of clinical services at the CRIA.