*Emergency Department Interventions for Opioid Use Disorder Treatment*
Authors: Cindy Parks Thomas PhD, Maureen T Stewart PhD, Cynthia Tschampl
PhD, Kumba Sennaar MS, Neto Coulibaly MS, Daniel Schwartz BS and Judith Dey
Research Objective: Opioid-related morbidity and overdose deaths continue
to be a significant public health problem. For individuals with opioid use
disorder (OUD), the emergency department (ED) is a critical entry point to
potentially access treatment. A growing strategy to improve access to care
for OUD and other substance use disorders (SUD) is through the ED, with
several hundred programs estimated to be in place. This study examined
several models of ED-based interventions for OUD, identifying key features,
population served, metrics for assessing effectiveness, barriers to, and
facilitators of success, and lessons for future programs.
Study Design: Case study of five ED-based OUD intervention programs in
different US regions, representing a wide range of models and populations.
Interviews with a range of stakeholders and staff, and document review.
Population Studied: Emergency department staff, peer/recovery navigators,
hospital administrators, community partners, and policy makers were
interviewed about treatment of patients with OUD and other SUD.
Principal Findings: A wide range of models successfully identify and
initiate OUD treatment in the emergency department, and have established
strong relationships with community partners for continued engagement.
Programs vary in their origin and motivation (initial developers and
funding), how they identify patients (by providers, electronic record
alerts, community awareness campaigns, post overdose, patient request
only), how they initiate treatment, how they use peer navigators or
substance use navigators, relationship with community partners, and metrics
used for success. Program informants report having continued during COVID,
often with telephonic peer support, and treatment initiation. ED OUD
programs are seen by communities and other stakeholders as filling an
important gap in care. There are a wide range of navigator-type positions
employed, where some are foundational to a program’s operations and others
have more circumscribed activities. Success in enrolling patients in MOUD
did not depend on navigators having lived experience. Many stakeholders
have found these programs to begin to address the stigma of treating
persons with OUD and SUD more broadly, and are using this as a model to
move beyond OUD identification and treatment to other substances, such as
alcohol use disorder (AUD) and stimulant use disorder. Challenges remain,
including sustained funding for programs initiated through federal or state
grants, and the best approaches to the role of navigator.
Conclusions: ED-based OUD programs are an important component in promoting
low-barrier OUD care, and are a model for identification and treatment of
other substance use disorders. Many models of care are in place.
Challenges include stigma among providers, sustainability beyond grant
funding, and available treatment capacity in community programs for
Implications for Policy or Practice: As ED OUD programs proliferate, it
will be important to understand the features of these programs, and their
contribution to a program’s success. It is also important to identify the
best metrics for evaluating such programs, for potential standardization.