On June 25, Yale School of Medicine’s Dr. Jeanette Tetrault spoke at a convening of the President’s Opioid Commission and the Office of National Drug Control Policy. The purpose of the meeting was to discuss the steps needed to build a national addiction medicine workforce and give Americans access to the care they need. Her talk, which focused on the role of addiction medicine specialists in emergency departments (EDs), was part of a congressional briefing sponsored by the American College of Academic Addiction Medicine.
“So why would EDs play a role in addressing this issue?” Tetrault asked the audience of over 50 health professionals and representatives of health systems. “The answer is plain and simple: It is where the patients are and it provides an on-demand, 24/7, 365 day-a-year option to meet patients where they are.”
Tetrault described one such patient, a 29-year-old man who visited the ED three times in one year before he admitted to injecting heroin, which contributed to his symptoms. His addiction started with experimentation with opioid pain pills that led to withdrawal symptoms when he wasn't taking them. He replaced the painkillers with heroin and subsequently lost his job, family support, and friends due to addiction.
“This is not an uncommon story,” Tetrault noted. “What is uncommon, however, is that in our ED at Yale New Haven Hospital, Dr. Gail D’Onofrio and her team developed a model to screen and assess patients for opioid use disorder and then initiate evidence-based addiction treatment in the ED, rather than giving them just a pamphlet with a phone number to call to seek treatment on their own at a later date.”
On his third visit, the patient Tetrault described was treated with a medication, buprenorphine, that curbs cravings for opioids. He was also given a buprenorphine prescription, a naloxone kit for use in the event of an overdose, and a “warm hand off” to Tetrault’s primary care clinic for ongoing care.
Research pioneered at Yale shows this comprehensive approach to addiction treatment, starting in the ED, is more effective in getting patients engaged in treatment than the standard of care, she noted.
Tetrault is associate professor of medicine and program director of the Addiction Medicine Fellowship at Yale. Her scholarly work focuses on care of patients with addiction and the medical conditions associated with substance use, mainly HIV and Hepatitis C.