MOUD in the ED

Opioid use disorder (OUD) is a chronic medical condition that presents with life threatening and decompensating symptoms. Though OUD poses significant risk to individual and public health, it can be treated effectively.

 

However, that treatment is not yet routine in emergency department and hospital settings.

• Between 2013 and 2018, ED visits related to substance use disorder (SUD) increased by 45%.
• Data collected during the COVID-19 public health emergency indicate that the proportion and volume of ED visits for SUD continue to rise.
• Fentanyl contributes heavily to the upward trends as compared to other drug-related visits.

• Despite the increased interaction between acute care settings and individuals with SUD, treatment initiation and referrals remain low in acute care settings.

   

This gap in treatment and referral is significant, especially considering this population is at a high risk for poor health outcomes and that EDs are high impact settings.

• The emergency department is often the primary source of care for patients with opioid use disorder.
• Over 50 percent of people who use opioids with high risk for overdose visit the ED in any 12-month period.
• The 12-month mortality for post-overdose patients 5.5% (median age 39), compared to an all cause 12-month mortality for non-overdose patients aged 14–74 of 1.7%.
  1. After adjustments, this means that that the mortality hazard is 3.5 times higher for overdose patients; in overdose patients who leave against medical advice, that number jumps to 7.1 (times higher).
  2. Of post-overdose visit deaths, one in five occur within 30 days of ED discharge. However, the naloxone and buprenorphine prescription rate within 30 days of an emergency department visit for opioid overdose is less than 9%.

The American College of Emergency Physicians published consensus recommendations on the treatment of opioid use disorder in the emergency department in 2021, templating and endorsing this best practice.

• Evidence has long demonstrated that medication for opioid use disorder (MOUD) is an effective treatment, reducing mortality, disease transmission, and criminal-legal system interactions.
• MOUD is the only treatment for OUD associated with reduced morbidity and mortality and does not need to be combined with behavioral health interventions to be effective.
• Initiating buprenorphine in the emergency department increases retention in treatment, decreases opioid use, and decreases system costs.
• Emergency physicians can translate this evidence into care delivery in their departments, furthering evidence-based practice, health equity, and addressing a national public health crisis by providing medications for opioid use disorder to this vulnerable population.
   

Emergency physicians can translate this evidence into care delivery in their departments, furthering evidence-based practice, health equity, and addressing a national public health crisis by providing medications for opioid use disorder to this vulnerable population.