Proposed Connecticut bill SB 365, which had a public hearing earlier this month and is undergoing review by the Office of Legislative Research and Office of Fiscal Analysis, would require emergency departments to offer buprenorphine to patients with opioid use disorder. I am an emergency medici ne doctor who works in addiction medicine, and while I wish we didn’t need a law to get doctors to treat opioid use disorder like any other emergency, I am optimistic that this bill is a step in the right direction to treat the opioid crisis in Connecticut. Many of my patients have achieved stability from medication treatments for opioid use disorder. Buprenorphine and methadone are medications that treat opioid withdrawal, decrease cravings for unprescribed opioids, and markedly reduce the opioid overdose risk. Study after study has shown that these medications work, including a 2020 study published in JAMA that found that being treated with buprenorphine or methadone is associated with a massive 76% reduction in the risk of overdose at three months. A Connecticut study found that treating opioid use disorder without these medications is associated with 77% higher risk of fatal opioid overdose than doing no treatment at all. An ER doctor would never fail to treat a life-threatening heart attack by treating the patient and activating the cardiology team, yet I have repeatedly seen colleagues decide not to start buprenorphine for a patient requesting it for opioid use disorder treatment, often due to a misunderstanding of the morbidity and mortality of opioid use disorder. One study found that patients who received naloxone, a medication that reverses opioid overdoses, have a one-year mortality rate higher than those who experience a life-threatening heart attack. I was surprised to see the Connecticut Hospital Association framing this as an unfunded mandate that will raise costs, when we have evidence of buprenorphine markedly lowering healthcare costs. This bill would save Connecticut taxpayers substantial money. The data speaks for itself:  Being treated with buprenorphine or methadone is associated with a 32% reduction in the risk of opioid-related emergency department visits, according to a 2020 study. Insurance data shows that when compared to not being treated with buprenorphine, patients prescribed buprenorphine have lower rates of outpatient charges, inpatient charges, and a lower overall yearly healthcare charge of over $20,000 per person. This translates to significant Medicaid savings for Connecticut taxpayers. I have seen firsthand the extraordinary healthcare costs that could have been prevented by starting buprenorphine in the emergency department, including heart infections, which cost on average almost $200,000 and often require open heart surgery, kidney failure leading to dialysis, spinal infections causing paralysis, and anoxic brain injuries requiring a lifetime of 24/7 medical care. It is devastating to see in a patient’s medical chart that they sought treatment in the emergency department, were turned away without starting medication or a bridge prescription, and then went on to have a terrible medical outcome. The bill has a proposed addition to require bridging the prescription for patients started on buprenorphine to last until their follow-up. I believe that a further addition should mandate that the bridge prescription include a minimum of at least 7 days. Follow-up can take place in many potential locations, including with an addiction provider, psychiatrist, primary care, and even via telehealth. Instead of buprenorphine, many patients with opioid use disorder choose the alternative treatment of methadone, which has many decades of research pointing to its efficacy. Another proposed addition to the bill is to add methadone as an option to fulfill the requirement of offering treatment. As long as clinically safe for the individual patient, this should be offered to the patient as an option. It would also be nice to see the law cover patients who are admitted to a medical or psychiatric hospital, not just those who seek emergency care. Not all patients will choose to take medication to treat their opioid use disorder, but not offering it is akin to denying antibiotics for sepsis. I hope Connecticut legislators will give their bipartisan support to SB 365 to help prevent unnecessary death and suffering in our state. Dr. Cara Borelli, DO is an addiction medicine physician who works at an inpatient addiction medicine consult service and teaches in New Haven. She is the co-editor-in-chief of the Journal of Child and Adolescent Substance Use. ...read more read less