Dora-Laskey Aaron, King Andrew, Sadler Richard
Department of Emergency Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.
Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
Am J Emerg Med. 2022 Jan;51:393-396. doi: 10.1016/j.ajem.2021.11.014. Epub 2021 Nov 11.
Emergency department (ED)-initiated buprenorphine/naloxone has been shown to improve treatment retention and reduce illicit opioid use; however, its potential may be limited by a lack of accessible community-based facilities. This study compared one state's geographic distribution of EDs to outpatient treatment facilities that provide buprenorphine treatment and identified ED and geographic factors associated with treatment access.
Treatment facility data were obtained from the SAMHSA 2018 National Directory of Drug and Alcohol Abuse Treatment Facilities, and ED data were obtained from the Michigan College of Emergency Physician's 2018 ED directory. Geospatial analysis compared EDs to buprenorphine treatment facilities using 5-, 10-, and 20-mile network buffers.
Among 131 non-exclusively pediatric EDs in Michigan, 57 (43.5%) had a buprenorphine treatment facility within 5 miles, and 66 (50.4%) had a facility within 10 miles. EDs within 10 miles of a Medicaid-accepting, outpatient buprenorphine treatment facility had higher average numbers of beds (41 vs. 15; p < 0.0001) and annual patient volumes (58,616 vs. 17,484; p < 0.0001) compared to those without. Among Michigan counties with EDs, those with at least one buprenorphine facility had larger average populations (286,957 vs. 44,757; p = 0.005) and higher annual rates of opioid overdose deaths (mean 18.3 vs. 13.0 per 100,000; p = 0.02) but were similar in terms of opioid-related hospitalizations and socioeconomic distress.
Only half of Michigan EDs are within 10 miles of a buprenorphine treatment facility. Given these limitations, expanding access to ED-initiated buprenorphine in states similar to Michigan may require developing alternative models of care.
急诊科启动的丁丙诺啡/纳洛酮已被证明可提高治疗依从性并减少非法阿片类药物的使用；然而，其潜力可能因缺乏便捷的社区设施而受到限制。本研究比较了一个州急诊科与提供丁丙诺啡治疗的门诊治疗机构的地理分布，并确定了与治疗可及性相关的急诊科和地理因素。
治疗机构数据来自美国药物滥用和精神健康服务管理局（SAMHSA）2018年全国药物和酒精滥用治疗机构目录，急诊科数据来自密歇根急诊医师学院2018年急诊科目录。地理空间分析使用5英里、10英里和20英里的网络缓冲区将急诊科与丁丙诺啡治疗机构进行比较。
在密歇根州的131家非专门收治儿科患者的急诊科中，57家（43.5%）在5英里范围内设有丁丙诺啡治疗机构，66家（50.4%）在10英里范围内设有该机构。与没有此类机构的急诊科相比，距离接受医疗补助的门诊丁丙诺啡治疗机构10英里范围内的急诊科平均床位数更多（41张对15张；p<0.0001），年患者量也更多（58,616人次对17,484人次；p<0.0001）。在设有急诊科的密歇根州各县中，至少有一家丁丙诺啡治疗机构的县平均人口更多（286,957人对44,757人；p=0.005），阿片类药物过量死亡年发生率更高（平均每10万人18.3例对13.0例；p=0.02），但在阿片类药物相关住院率和社会经济困境方面相似。
密歇根州只有一半的急诊科距离丁丙诺啡治疗机构在10英里范围内。鉴于这些限制，在与密歇根州类似的州扩大急诊科启动的丁丙诺啡的可及性可能需要开发替代护理模式。
