Reddy Neha G, Jacka Brendan, Ziobrowski Hannah N, Wilson Taneisha, Lawrence Alexis, Beaudoin Francesca L, Samuels Elizabeth A
Warren Alpert Medical School of Brown University, Providence, RI, United States of America.
Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America.
J Subst Abuse Treat. 2021 Dec;131:108588. doi: 10.1016/j.jsat.2021.108588. Epub 2021 Aug 5.
Emergency department (ED) visits for opioid-related overdoses continue to rise across the United States, particularly among Black, Latinx, and American Indian/Alaskan Native communities. A minority of people with opioid use disorder (OUD) engages in formal addiction treatment and there are racial disparities in treatment access. ED visits for opioid overdose are crucial opportunities to link individuals with OUD to harm reduction and treatment services. However, we know little about whether racial inequities exist in ED treatment after opioid overdose.
This observational, cross-sectional study examined differences in services provided to overdose patients who were discharged after an ED visit for opioid overdose by patient race-ethnicity. Primary outcomes included provision of take-home naloxone, ED-based behavioral counseling, and linkage to treatment. Race-ethnicity differences in post-overdose ED services were evaluated using chi-square analyses, and multivariable logistic regression analyses were conducted to examine associations of race-ethnicity with receiving post-overdose services, controlling for other institutional-, provider-, and patient-level factors.
From September 2017 to February 2020, 734 patients were discharged from the ED for an opioid-related overdose. Most patients were White non-Latinx (70.0%), 8.9% were Black non-Latinx, 3.3% were Other race non-Latinx, and 18.0% were Latinx. Take-home naloxone was the most frequent intervention provided to patients while behavioral counseling was the lowest across all race-ethnicity categories. There were no statistically significant differences in provision of take-home naloxone and treatment referral based on patient race-ethnicity. However, a lower proportion of discharged Black non-Latinx patients received behavioral counseling compared to patients of other race-ethnicities, and the odds of receiving behavioral counseling was significantly higher for White non-Latinx (OR: 1.75; 95% CI: 1.00, 3.06); Latinx (OR: 2.06; 95% CI: 1.05, 4.06); and Other race non-Latinx (OR: 3.29; 95% CI: 1.18, 9.15) patients compared to Black non-Latinx patients.
Black non-Latinx patients discharged from the ED for an opioid-related overdose were less likely to receive behavioral counseling compared to non-Black patients. Possible reasons for this decreased provision of behavioral counseling include provider bias, patient mistrust of the medical and behavioral health care systems, and limited provider training in addiction medicine and motivational interviewing. These inequities add to the known racial disparities in ED patient care. Further research should elucidate barriers to behavioral counseling within ED settings and factors contributing to racial inequities in post-overdose emergency care.
在美国，因阿片类药物过量而前往急诊科（ED）就诊的人数持续上升，尤其是在黑人、拉丁裔以及美国印第安/阿拉斯加原住民社区。少数患有阿片类药物使用障碍（OUD）的人会接受正规的成瘾治疗，而且在治疗可及性方面存在种族差异。因阿片类药物过量前往急诊科就诊是将患有OUD的个体与减少伤害和治疗服务相联系的关键契机。然而，我们对阿片类药物过量后在急诊科治疗中是否存在种族不平等知之甚少。
这项观察性横断面研究通过患者种族/族裔，调查了因阿片类药物过量在急诊科就诊后出院的过量用药患者所接受服务的差异。主要结局包括提供纳洛酮带回家、基于急诊科的行为咨询以及与治疗的联系。使用卡方分析评估过量用药后急诊科服务中的种族/族裔差异，并进行多变量逻辑回归分析，以检验种族/族裔与接受过量用药后服务之间的关联，同时控制其他机构、提供者和患者层面的因素。
2017年9月至2020年2月期间，734名患者因与阿片类药物相关的过量用药从急诊科出院。大多数患者是白人非拉丁裔（70.0%），8.9%是黑人非拉丁裔，3.3%是其他种族非拉丁裔，18.0%是拉丁裔。纳洛酮带回家是提供给患者最频繁的干预措施，而行为咨询在所有种族/族裔类别中是最少的。基于患者种族/族裔，在提供纳洛酮带回家和治疗转诊方面没有统计学上的显著差异。然而，与其他种族/族裔的患者相比，出院的黑人非拉丁裔患者接受行为咨询的比例较低，白人非拉丁裔（比值比：1.75；95%置信区间：1.00，3.06）、拉丁裔（比值比：2.06；95%置信区间：1.05，4.06）以及其他种族非拉丁裔（比值比：3.29；95%置信区间：1.18，9.15）患者接受行为咨询的几率显著高于黑人非拉丁裔患者。
因阿片类药物过量从急诊科出院的黑人非拉丁裔患者与非黑人患者相比，接受行为咨询的可能性较小。行为咨询提供减少的可能原因包括提供者偏见、患者对医疗和行为健康护理系统的不信任，以及提供者在成瘾医学和动机性访谈方面的培训有限。这些不平等加剧了急诊科患者护理中已知的种族差异。进一步的研究应阐明急诊科环境中行为咨询的障碍以及导致过量用药后急诊护理中种族不平等的因素。
