For Dr. Paul Updike, the medical director for Substance Use Services for the Catholic Health System in Buffalo, NY, this approach is the “treatment of choice.” But he notes that different treatments should be “complementary, not exclusive of one another.”

There’s a growing consensus that emergency departments should work aggressively to offer medication-assisted treatment to every overdose victim immediately—at the moment when they are most vulnerable to relapse.According to the Recovery Research Institute,the window of time between referring a person to treatment and his or her actual appointment, if too long, could result in loss of motivation. Many addiction specialists fear that after 24 to 72 hours, a patient might already be in acute opioid withdrawal, and at increased risk to use—and overdose—yet again.

“If you have a diabetic patient whose blood pressure is too high, and a few weeks later, the blood pressure got too high again, you don't kick him out of the diabetic clinic,” says Dr. John Aldis, an addiction medicine specialist in the Eastern Panhandle of West Virginia. “You welcome them back in, you get them back on treatment, as often as is needed. And that isn't being done in addiction medicine.”

At Massachusetts General Hospital in Boston, people who have overdosed are sent home with a prescription for a drug that combines buprenorphine and naloxone (sold under the brand name Suboxone). Unlike methadone, which is a Schedule II drug and requires a DEA license to prescribe, buprenorphine can be prescribed and given to individuals right in a doctor’s office. According to the Drug Addiction Treatment Act of 2000, doctors can prescribe buprenorphine in a variety of settings including community hospitals, health departments, and prisons. On the other hand, methadone maintenance treatment can only be performed in a Substance Abuse and Mental Health Services Administration (SAMHSA)-certified clinic.

In Western New York, many hospitals are connected with Cheryll Moore’s task force. “Each case is slightly different,” Moore says. In general, overdose victims are transported to the local emergency department after overdoses occur; at 13 of those emergency departments, staff are trained and registered to provide and prescribe Suboxone. Moore’s task force is responsible for having trained 150 of those providers in the past few years. Additionally, the individual is given an appointment with a nearby long-term treatment provider within two to seven days after the ER visit if the individual so chooses to pursue long-term care.

“We currently have a network of 27 community-based substance use disorder providers that have allocated more than 60 slots weekly for immediate appointments and continuation of medication-assisted treatment,” Moore says. This is necessary because the initial prescription from the ED is only valid for a week—then the patient is advised to follow through with the arranged long-term treatment. If a client is uninsured, the task force has set up a process with a local Congressional Budget Office to accept donations to pay for the first week of medication for the individual.

This means that there are essentially two paths for a person who has overdosed in Buffalo: If a person enters an M.A.T.-participating emergency room, he or she can find long-term care immediately. If the person overdoses in Cheektowaga, he or she might still receive the same treatment at the ER (if that particular hospital has Suboxone providers), but that person will also have received the orange packet from law enforcement containing information about peer support and M.A.T.

Until all emergency rooms can provide Suboxone or methadone on demand, community providers are doing the best they can to engage people in treatment. In Buffalo, the task force and peer system seem to be making a difference.

At the Catholic Health System Methadone Clinic, the first of its kind in Buffalo, Dr. Updike is focusing on making sure people with opiate use disorder are stabilized with medication-assisted treatment so they can get back on track.

“When patients aren’t having to deal with the demand of their addiction every day, then things change dramatically,” he says. “There’s concurrent care here—a counselor, nursing staff…medication is an important piece of the treatment, though.”

In general, medication-assisted treatment works because opiate use disorder is a chronic, life-threatening illness characterized by changes in the brain. According to Dr. Updike, these changes drive the stigmatizing behaviors often associated with addiction—like criminality and joblessness—and medication is necessary for a successful recovery. “If we don't address that underlying problem, then patients will struggle,” he explains.