Emergency Department Administration of Medications for Opioid Use Disorder Varies by Patient Clinical Presentation

Researchers conducted a mixed methods study to examine variability in the provision of medications for opioid use disorder (buprenorphine and methadone; MOUD) and naloxone prescribing among patients presenting to three US emergency departments (EDs) with one of three conditions: opioid overdose, opioid withdrawal, or other OUD-related concerns. Researchers then conducted focus groups with providers to gain insights into treatment variability in these different clinical scenarios.

• There were 1339 OUD-related visits during the study period: 265 visits for overdose (20 percent), 123 for opioid withdrawal (9 percent), and 951 for other OUD-related conditions (71 percent).
• Overall, 23 percent of patients received MOUD during or after their ED visit, most commonly buprenorphine. MOUD provision was least common among people treated after an overdose (6 percent), and most common among patients experiencing opioid withdrawal (69 percent).
• Naloxone was prescribed in less than one-third of visits (31 percent), most commonly after a visit for overdose (45 percent of overdose visits).
• There were 28 focus group participants (physicians and nurses) who highlighted different opportunities and challenges delivering care for the three patient groups:
  • Key factors identified for successful treatment initiation included perceived patient receptivity, provider confidence, and patient clinical readiness.
  • Participants felt most comfortable starting buprenorphine in patients presenting with opioid withdrawal. However, lack of adequate treatment of withdrawal symptoms during the ED visit, and severity of these symptoms, could impact whether someone was started on MOUD.
  • Patients’ mistrust in the medical system, and clinician uncertainty about OUD treatment were seen as significant contributors to missed opportunities to initiate treatment and/or link people to care and services.
  • Participants felt uncertainly and a lack of preparedness about treating patients with chronic pain.

Comments: Overall, this study found significant variability in ED MOUD and naloxone provision to patients with various OUD clinical presentations. They also found clinician-reported variability in clinician confidence, patient readiness, and clinician-perceived patient receptivity to OUD treatment across all clinical scenarios. Incorporating tailored ED guidance for various clinical presentations of OUD may improve clinician comfort and knowledge, and close treatment gaps.

Elizabeth A. Samuels, MD, MPH, MHS

Reference: Faude S, Delgado MK, Perrone J, et al. Variability in opioid use disorder clinical presentations and treatment in the emergency department: A mixed-methods study. Am J Emerg Med. 2023;66:53–60.