The Washington State Health Care Authority (HCA) is launching a program that expands access to medications for opioid use disorder (MOUD). The program, ScalaNW, equips emergency room clinicians with tools to treat patients for opioid use disorder and connect them to community-based care.
Opioid use has accelerated dramatically in recent years in Washington. Between 2019 and 2021, the number of Washingtonians who died of opioid drug overdoses doubled, according to HCA. MOUD, like methadone and buprenorphine, can help in combatting opioid-related deaths, with studies showing these medications can cut death rates in half. MOUD use increases retention in treatment, decreases opioid use and decreases healthcare system costs, all without causing harm to patients. Still, less than 9 percent of overdose-related emergency room visits result in a prescription for MOUD.
“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 OUD connect with medical care,” said Dr. Charissa Fotinos, M.D., M.S.c., HCA’s state Medicaid director, in a statement. “Our goal is to give ER clinicians the support they need to administer lifesaving medication for patients in need of care, and ScalaNW is a tool that helps us meet that goal.”
MOUD have been under-prescribed in the ER for a reason: before 2023, the U.S. Drug Enforcement Agency required clinicians to complete special training to prescribe certain medications for OUD. These requirements were removed at the end of 2022. Now that the medication is easier to prescribe, clinicians and hospital systems can standardize treatment protocols and consistently get medication to ER patients with OUD. ScalaNW is a bridge program with tools to close that gap between emergency initiation of MOUD and the ongoing, outpatient clinical care they needed to keep patients on medication long-term.
ScalaNW is designed to equip ER clinicians with the knowledge and skills they need to treat patients with OUD. The program website, ScalaNW.org, offers evidence-backed protocols for clinicians to determine how and when to provide MOUD and collaborates with the University of Washington (UW) Psychiatry Consultation Line (PCL) to offer 24/7 live clinical support.
ScalaNW also works with the Washington Recovery Helpline to provide 24/7 scheduling that allows follow-up appointments to be made before ER discharge.
“ScalaNW delivers what ER clinicians need to confidently assess and treat people with OUD: evidence-backed, accessible information to quickly guide treatment,” said Dr. Chris Buresh, M.D., M.P.H., assistant program director at University of Washington Emergency Medicine Residency Program and a practicing physician at UW Harborview Medical Center and Seattle Children’s, in a statement.
Buresh was part of a partnership that developed the medical protocols for ScalaNW, which included HCA, University of Washington School of Medicine Emergency Medicine, UW Addictions, Drug and Alcohol Institute (ADAI), and UW Psychiatry and Behavioral Sciences PCL.
“I’m confident that the tools offered through ScalaNW will help get these important medications to those who need them,” Buresh added.
ScalaNW will provide all Washington hospitals with 24/7 clinical consultation and practice guidelines along with educational resources for both patients and providers. Hospitals that join the ScalaNW network will also receive technical assistance with policies, billing and implementation, support for staff education and 24/7 scheduling for follow-up appointments.
