A 54-year-old man with a history of schizophrenia presented to the emergency room for weakness with associated lacrimosis, drooling, nausea, emesis, diarrhoea, diplopia and burning sensation on his skin that began 6 hours after spraying five cans of Raid on his carpet. He was noted to have miotic pupils and hyperactive bowel sounds. Given the clinical presentation, the patient was diagnosed with organophosphate (OP) toxicity. After being admitted, he developed symptoms associated with his OP toxicity and was successfully treated with atropine and pralidoxime. Most Raid products contain pyrethroids; however, both OPs and pyrethroids are available in commercial pesticides and patients may misidentify ingestions. There are limited data reporting the toxicity of pyrethroid overdose in humans and to guide its subsequent treatment. It is crucial to keep a low threshold for diagnosing and treating patients with acute onset of symptoms suspicious for an OP or pyrethroid toxidrome.

Introduction: The seemingly inexorable rise of opioid-related overdose deaths despite the reduced number of COVID-19 pandemic deaths demands novel responses and partnerships in our public health system’s response. Addiction medicine is practiced in a broad range of siloed clinical environments that need to be included in addiction medicine training beyond the traditional fellowship programs. Our objective in this project was to implement a knowledge-based, live virtual training program that would provide clinicians and other healthcare professionals with an overview of addiction, substance use disorders (SUD), and clinical diagnosis and management of opioid use disorder (OUD). Methods: The Veterans Health Administration (VHA) Emergency Department Opioid Safety Initiative (ED OSI) offered a four-day course for healthcare professionals interested in gaining knowledge and practical skills to improve VHA-based SUD care. The course topics centered around the diagnosis and treatment of SUD, with a focus on OUD. Additionally, trainees received six months of support to develop addiction medicine treatment programs. Evaluations of the course were performed immediately after completion of the program and again at the six-month mark to assess its effectiveness. Results: A total of 56 clinicians and other healthcare professionals participated in the Addiction Scholars Program (ASP). The participants represented nine Veteran Integrated Service Networks and 21 different VHA medical facilities. Nearly 70% of participants completed the initial post-survey. Thirty-eight respondents (97.4%) felt the ASP series contained practical examples and useful information that could be applied in their work. Thirty-eight respondents (97.4%) felt the workshop series provided new information or insights into the diagnosis and treatment of SUD. Eleven capstone projects based on the information acquired during the ASP were funded (a total of $407,178). Twenty participants (35.7%) completed the six-month follow-up survey. Notably, 90% of respondents reported increased naloxone prescribing and 50% reported increased prescribing of buprenorphine to treat patients with OUD since completing the course. Conclusion: The ASP provided healthcare professionals with insight into managing SUD and equipped them with practical clinical skills. The students translated the information from the course to develop medication for opioid use disorder (M-OUD) programs at their home institutions.

Background/Objectives: The VA Emergency Medicine Addiction Hotline (VEMAH) is a real-time telehealth addiction consult service for Veterans Health Administration (VHA) providers in acute-care settings. VEMAH launched in May 2023 across eight Veterans Integrated Service Network 22 (VISN 22) facilities, expanding to 17 total VHA sites over 3 years. Results: Over 38 months (May 7, 2023 through July 23, 2026), the service completed 2,154 encounters, including real-time e-consults, direct patient tele-care, care coordination, proactive tele-outreach, and provider education. The most common indications for consultation were opioid- and alcohol-related concerns. Pain-related concerns accounted for about 11% of all encounters. VEMAH providers focused on proactive outreach, substance use disorder (SUD) pharmacotherapy interventions, and coordinating care with local SUD services for ongoing treatment. Conclusions: We describe the feasibility of implementing and scaling a real-time telehealth addiction consult service across VHA acute care settings. A descriptive comparison of ED OSI dashboard trends before and after VEMAH implementation showed positive concurrent trends in naloxone and buprenorphine prescribing within VISN 22, though these observations are hypothesis-generating rather than confirmatory. These findings support VEMAH as a scalable model for extending addiction care access across VHA acute-care settings.