Harbor:Opiate Withdrawal/MAT/BUP: Difference between revisions

Latest revision as of 19:22, 27 December 2022

MAT/BUP/Opiate Withdrawal

Patient MAT/Buprenorphine Follow Up Options

Insurance	Clinic	Hours
DHS Empaneled to Internal Med or DHS Eligible	Primary Care & Diagnostic Center (PCDC) - Basement Clinic C 1000 W Carson St Torrance, CA 90502 (424) 306-4546	ED provider to submit PVCC/CCC form" Depart --> ED Post Visit Plan --> CCC-HAR --> free text in the "for Referral" box. No longer taking walk-ins, clerk does NOT book appt. For questions, please message Chris O. Brown, MD via ORCHID/Outlook
DHS Empaneled to Fam Med or DHS Eligible	Lomita Fam Med Clinic 1430 W Lomita Blvd, 2nd Floor Harbor City, CA 90710 (310) 602-2600 (424) 306-4193 - SUD Counselor	Walk-In: Tuesday AM or Friday AM For questions, please message Gloria Sanchez, MD via ORCHID/Outlook
DHS Empaneled, DHS Eligible, MyHealthLA, Uninsured (No OOP)	LAC+USC Urgent Care 2051 Marengo St, 2nd Floor Los Angeles, CA 90033 (323) 409-1000	Walk-In: Tuesday-Thursday & Saturday 8am-7pm
All Patients	Tarzana Treatment Center 5190 Atlantic Blvd Long Beach, CA 90805 (818) 654-3933	Walk-In: 24/7

All patients can call the Substance Abuse Service Hotline 24/7 for more help (844) 804-7500

Please refer all DHS unempaneled patients with substance use disorder (SUD) started on medication assisted treatment (MAT) to PVCC/CCC – Har for enrollment in Dr. Brown's addiction clinic
- In the "For referral, specify need" box: "MAT for opiate dependency"
  - Qualifying patients
    - Active withdrawal or post-overdose: start buprenorphine in ED via buprenorphine protocol
    - Not in active withdrawal but with opioid use disorder: Rx for home start using home initiation protocol
Empaneled patients: Patients with chronic pain and opioid dependence, message PCP to refer patients into a MAT clinic, AND CC Christopher Brown AND Gloria Sanchez to link patient to Harbor SUD clinics
Empaneled to Lomita/Fam Med, then message/consult FM MAT (see below) to get referral into FAM MAT clinic.
For pregnant patients - once the primary complaint is addressed (or if primary complaint is pregnant and opiate use disorder/withdrawal), if patient has confirmed IUP please send to OB triage for initiation of Suboxone during pregnancy

Additional resources:
- FM MAT Inpatient Consult Service - opiate and meth use (excludes isolated EtOH use)
  - For patients 16y/o and older
    - Mon-Thur 8a-4p p0990 or call (310) 697-6030
    - Message Center: Yvettte Cerna
    - If afterhours, MAT team will call patient for follow up
    - Flyer: FM MAT Consult Service.pdf
- MAT Provider Consult Line
  - DHS on-call providers available to help initiate MAT for patients with alcohol and/or opioid use disorder
    - (213) 288-9090
    - 8a-MN, 7 days per week
    - Flyer: Mat Consult Line.pdf

Narcan Distribution from ED

Available for any patients that meet criteria for Narcan distribution and would benefit from distribution
- In Code White cabinet in purple doc box, next to the adult airway cabinet, requires key from either senior resident phones or either attending phones
- Please initial to log the distribution on the clipboard attached, no PHI is required
All patients distributed Narcan also need it prescribed to the pharmacy for tracking purposes
Please document as you otherwise would for prescribing Narcan, with the addition of .ednaloxonegiven in your note, which can soon be replaced by .naloxoneEDdistribution
How to use intranasal narcan
Faculty/Resident Sponsors: Wu/Golden (2021)

@@ Line 1: / Line 1: @@
 ===[[Harbor:Opiate Withdrawal/MAT/BUP|MAT/BUP/Opiate Withdrawal]]===
-* Please refer all '''DHS patients with substance use disorder''' (SUD) started on medication assisted treatment (MAT) to '''PVCC/CCC – Har for enrollment in Dr. Brown's addiction clinic'''
-** In the "For referral, specify need" box: '''"MAT for opiate/alcohol dependency"'''
-*** Qualifying patients
-**** Active withdrawal or post-overdose: start buprenorphine in ED via buprenorphine protocol
-**** Not in active withdrawal but with opioid use disorder: rx for home start using home initiation protocol
-**** Patients with chronic pain and opioid dependence with PMD at Harbor: message PMD AND Christopher Brown AND Gloria Sanchez to link patient to Harbor SUD clinics
-**** For pregnant patients - once the primary complaint is addressed (or if primary complaint is pregnant and opiate use disorder/withdrawal), if patient has confirmed IUP please send to OB triage for initiation of Suboxone during pregnancy
-* Additional resources:
-** '''FM MAT Inpatient Consult Service'''
-*** For patients 16y/o and older
-**** Mon-Thur 8a-4p x64398
-**** call (310) 697-6030
-**** Message Center:  Yvettte Cerna
-****Flier: [[:File:FM MAT Consult Service.pdf|FM MAT Consult Service.pdf]]
-** '''MAT Provider Consult Line'''
-***DHS on-call providers available to help initiate MAT for patients with alcohol and/or opioid use disorder
-****(213) 288-9090
-****8a-MN, 7 days per week
-****Flier: [[:File:MAT Consultation Line.pdf|Mat Consult Line.pdf]]
-'''Narcan Distribution from ED'''
-*Available for any patients that meet criteria for Narcan distribution and would benefit from distribution
-**In Code White cabinet in purple doc box, next to the adult airway cabinet, requires key from either senior resident phones or either attending phones
-**Please initial to log the distribution on the clipboard attached, no PHI is required
-*All patients distributed Narcan also need it prescribed to the pharmacy for tracking purposes
-*Please document as you otherwise would for prescribing Narcan, with the addition of .ednaloxonegiven in your note, which can soon be replaced by .naloxoneEDdistribution
-*Thank you for helping!
-====BUP/MAT Treatment and Discharge Pathway====
-*[[:File:Bup_Protocol_Harbor.pdf|Harbor Bup Protocol.pdf]]
-====Patient Discharge Handout====
-*[[:File:Harbor_Bup_Start_Instructions.pdf|Bup Start Instructions.pdf]]
-====BUP Home Initiation====
-*[[:File:Bup home Initiation.pdf|Bup Home Start.pdf]]
 ====Patient MAT/Buprenorphine Follow Up Options====
 {| class="wikitable"
@@ Line 46: / Line 5: @@
 ! Insurance !! Clinic !! Hours
 |-
-| DHS Empaneled and DHS Eligible (not Harbor Family Medicine) || Primary Care & Diagnostic Center (PCDC) - Basement Clinic C
+| DHS Empaneled to Internal Med or DHS Eligible || Primary Care & Diagnostic Center (PCDC) - Basement Clinic C
 W Carson St<br/>
 Torrance, CA 90502<br/>
 (424) 306-4546
-  || '''Schedule as "HAR PC MAT New"''' or
+  || '''ED provider to submit PVCC/CCC form"'''
-'''Walk-In: Monday AM or Thursday AM'''<br/>
+'''Depart --> ED Post Visit Plan --> CCC-HAR --> free text in the "for Referral" box'''.   No longer taking walk-ins, clerk does NOT book appt.  For questions, please message Chris O. Brown, MD via ORCHID/Outlook
-For questions, please message Chris O. Brown, MD via ORCHID/Outlook
 |-
-| DHS Empaneled and DHS Eligible || Lomita Clinic
+| DHS Empaneled to Fam Med or DHS Eligible || Lomita Fam Med Clinic
 W Lomita Blvd, 2nd Floor<br/>
 Harbor City, CA 90710<br/>
@@ Line 79: / Line 37: @@
 |}
 All patients can call the Substance Abuse Service Hotline 24/7 for more help (844) 804-7500
+* Please refer all '''DHS unempaneled patients with substance use disorder''' (SUD) started on medication assisted treatment (MAT) to '''PVCC/CCC – Har for enrollment in Dr. Brown's addiction clinic'''
+** In the "For referral, specify need" box: '''"MAT for opiate dependency"'''
+*** Qualifying patients
+**** Active withdrawal or post-overdose: start buprenorphine in ED via buprenorphine protocol
+**** Not in active withdrawal but with opioid use disorder: Rx for home start using home initiation protocol
+* '''Empaneled patients:''' Patients with chronic pain and opioid dependence, message PCP to refer patients into a MAT clinic, AND CC Christopher Brown AND Gloria Sanchez to link patient to Harbor SUD clinics
+* '''Empaneled to Lomita/Fam Med''', then message/consult FM MAT (see below) to get referral into FAM MAT clinic.
+* For pregnant patients - once the primary complaint is addressed (or if primary complaint is pregnant and opiate use disorder/withdrawal), if patient has confirmed IUP please send to OB triage for initiation of Suboxone during pregnancy
+* Additional resources:
+** '''FM MAT Inpatient Consult Service''' - opiate and meth use (excludes isolated EtOH use)
+*** For patients 16y/o and older
+**** Mon-Thur 8a-4p p0990 or call (310) 697-6030
+**** Message Center:  Yvettte Cerna
+****If afterhours, MAT team will call patient for follow up
+****Flyer: [[:Media:FM MAT Consult Service.pdf|FM MAT Consult Service.pdf]]
+** '''MAT Provider Consult Line'''
+***DHS on-call providers available to help initiate MAT for patients with alcohol and/or opioid use disorder
+****(213) 288-9090
+****8a-MN, 7 days per week
+****Flyer: [[:Media:MAT Consultation Line.pdf|Mat Consult Line.pdf]]
+'''Narcan Distribution from ED'''
+*Available for any patients that meet criteria for Narcan distribution and would benefit from distribution
+**In Code White cabinet in purple doc box, next to the adult airway cabinet, requires key from either senior resident phones or either attending phones
+**Please initial to log the distribution on the clipboard attached, no PHI is required
+*All patients distributed Narcan also need it prescribed to the pharmacy for tracking purposes
+*Please document as you otherwise would for prescribing Narcan, with the addition of .ednaloxonegiven in your note, which can soon be replaced by .naloxoneEDdistribution
+* [https://www.bing.com/videos/search?q=Narcan+adapt+how+to+use&&view=detail&mid=3FE0F53C308009BA8ADF3FE0F53C308009BA8ADF&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3DNarcan%2Badapt%2Bhow%2Bto%2Buse%26FORM%3DHDRSC4 How to use intranasal narcan]
+*Faculty/Resident Sponsors:  Wu/Golden (2021)
+====BUP/MAT Treatment and Discharge Pathway====
+*[[:Media:Bup_Protocol_Harbor.pdf|Harbor Bup Protocol.pdf]]
+====Patient Discharge Handout====
+*[[:Media:Harbor_Bup_Start_Instructions.pdf|Bup Start Instructions.pdf]]
+====BUP Home Initiation====
+*[[:Media:Bup home Initiation.pdf|Bup Home Start.pdf]]
 ==See Also==