The M Health Fairview First Step program provides rapid, evidence-based opioid use disorder treatment in the emergency department
M Health Fairview University of Minnesota Medical Center’s Emergency Department is piloting First Step, an innovative addiction treatment program, offering free, same-day access to medication for opioid use disorder in the emergency department. This initiative provides critical support when and where it’s needed most.
The communities served by the medical center are disproportionately impacted by the opioid crisis, with some of the highest overdose death rates in Minnesota. These communities also experience some of the worst racial disparities in overdose outcomes nationwide, underscoring the urgent need for accessible and effective treatment in a setting where clinicians are uniquely positioned to interact with individuals experiencing opioid use disorder.
“As frontline care providers, we see the devastating impact of addiction long before it is reflected in official statistics,” said Dziwe Ntaba, MD, an emergency department provider at M Health Fairview. “Effective treatment is essential to overcoming this crisis.”
Ntaba added, “Ninety-four percent of patients with substance use disorder don't receive any treatment, yet many frequently visit the ER. The emergency department presents a unique opportunity to fill that gap.”
Administration of buprenorphine (also known as Suboxone or Brixadi) in the emergency department more than doubles the likelihood that a patient will follow up in an outpatient clinic. When given at the correct dose, this medication further improves a patients’ retention in treatment and their mortality rate.
Developed in partnership with the Minneapolis Health Department’s Opioid Response Team, the First Step program at M Health Fairview University of Minnesota Medical Center – West Bank coincides with M Health Fairview’s participation in the Bridge National Expansion Project. The medical center is the only emergency department in Minnesota to join this national cohort of 300 hospitals across 15 states, setting a new standard in long-term recovery by treating patients with opioid use disorder immediately upon arrival to the emergency department, breaking down barriers that often hinder recovery.
The Minneapolis Health Department provided $389,000 to fund the pilot.
“We are committed to helping those suffering from substance misuse,” said Deputy Commissioner Heidi Ritchie, Minneapolis Health Department. “With medications like Suboxone, we can help people move into recovery, but urgency is key.”
Reducing barriers to recovery
Evidence shows that medications for addiction treatment, like buprenorphine, can reduce cravings, prevent overdoses, stop withdrawal symptoms, and significantly improve patient outcomes. When clinically indicated, patients in the First Step program receive rapid, same-day access to medications for addiction treatment.
Emergency department providers are trained to administer an opioid overdose reversal drug such as naloxone as needed, offer relief from withdrawal symptoms by prescribing fast-acting medications, and provide access to longer-term resources for recovery. A dedicated substance use navigator provides 1:1 support for patients in addiction crises by offering education, emotional support, and assistance in connecting with ongoing treatment resources. The emergency department team is also developing a culture of harm reduction across the hospital to help destigmatize opioid use disorder.
This “medication first” treatment model, grounded in decades of research, leverages existing care systems and evidence-based treatments. It also fosters collaboration between medical and psychosocial providers to retain patients in treatment and reduce opioid-related deaths.
Promising results
Since launching in June 2023, the First Step program has shown promising results:
- Over 500 patients connected with ongoing treatment and peer support.
- 75% of patients received buprenorphine or instructions for self-administration.
- Over two-thirds of First Step encounters included consultation with a Substance Use Navigator, who assists with prescription access and referrals.
M Health Fairview's Community Advancement team has been instrumental in letting community members know about the First Step program through their established network of community partners. The outreach team has coordinated multiple events and educational sessions in community locations, including health fairs serving unhoused community members, pop-up mobile resource events, and overdose prevention ambassador groups.
A national crisis
In Minnesota and across the country, the opioid crisis is staggering. The availability and addiction to fentanyl has rapidly outpaced other illicit opioid use, such as heroin, morphine, and oxycodone, and continues to rise. More than 1,000 Minnesotans died from an opioid-involved drug overdose in 2022 – up from 421 people in 2017, according to the Minnesota Department of Health. These numbers include growing disparities in outcomes across different racial, socioeconomic, and geographic populations — partly driven by limited access to evidence-based medications. Native American Minnesotans are nine times as likely to die from an opioid overdose compared to white Minnesotans and Black Minnesotans are three times as likely to die.
“The opioid epidemic is not going away, especially with such highly addictive synthetic opioids like Fentanyl being mixed into all sorts of street drugs,” saidTopher McMenemy, RN, patient care supervisor in the adult emergency department at M Health Fairview. “We are in the middle of a public health crisis that necessitates a shift in thinking. Drug addiction is not a moral failing. Opioid use disorder is a medical condition and we must treat it like any other chronic illness."
