Referrals to Ongoing Care Following MOUD Starts from the Acute Care Setting

What should I have in place prior to discharging a patient who has been initiated on buprenorphine or methadone?

Because a discharge prescription will likely be needed, it is helpful to have one or more prescribers with a DATA 2000 x-waiver available during day shifts to prescribe buprenorphine.

Until a routine relationship is established with a local provider or clinic, it is recommended to call a local buprenorphine prescriber (see SAMHSA database at https://tinyurl.com/mtyjtm5) before buprenorphine starts to arrange an appointment for patient. Ideally, this appointment will be within 3 days of discharge.

Similarly, for methadone it is important to call an outpatient methadone clinic prior as soon as possible after admission to arrange for follow up. Physicians outside of these programs cannot prescribe methadone for addiction, therefore discharge prescriptions cannot be written by hospital providers.

What if there are not many outpatient buprenorphine or methadone prescribers in my community?

This is a challenge in many communities. As more providers are receiving their x-waivers, there are more communities where buprenorphine is easier to access outpatient than methadone, therefore may be a better choice logistically. In California, the Hub and Spoke project will be supporting local providers (“spokes”) in prescribing buprenorphine through close partnerships with expert “hubs.” Please see http://www.uclaisap.org/ca-hubandspoke/ for more information.

You can use the SAMHSA treatment finder to locate providers with X waivers in your community (https://tinyurl.com/mtyjtm5) and reach out to see if they would be able to accept your patients. If no providers are available in your community at this point, options like Groups (http://www.chcf.org/projects/2017/groups), Project Echo (https://echo.unm.edu/nm-teleecho-clinics/opioid/), and telemedicine prescribing such as through Bright Heart Health (https://www.brighthearthealth.com/) may be good options for building local capacity.