Emergency Department-Based Medication for Opioid Use Disorder: A 5-Year Experience.

INTRODUCTION

Medication for opioid use disorder (MOUD) programs are effective in treating opioid use disorder (OUD). Successful programs are resource-intensive. We describe our 5-year emergency department (ED)-based MOUD program results.

METHODS

Our MOUD program uses Addiction Care Coordinators to coordinate care for OUD patients presenting to our ED. Peer recovery specialists provide counseling. Our MOUD program is available daily at our 2 hospitals. In 2021, we expanded our MOUD program to our 2 free-standing EDs using a telemedicine platform. Outcomes included the number of patients inducted over 5 years (2019-2023), the number inducted through telehealth, and the retention rate in the MOUD outpatient program at 1 and 6 months.

RESULTS

All 373,797 ED patients were screened for OUD over the 5 years, and 1072 (2.8%) were inducted into the MOUD program. A total of 53 patients (4.9%) were inducted through telemedicine. The number of patients inducted declined yearly; however, inpatient admissions for OUD declined less. The overall retention rate was 36.5% at 1 month and 28.8% at 6 months and then declined yearly. According to state data, the number of opioid and buprenorphine prescriptions also went down during this 5-year period.

DISCUSSION

ED-based MOUD programs expand access to treatment for patients with OUD. Patients' use of the ED-based MOUD program has declined each year, and retention rates have fallen. Several factors could be involved, such as increased strength of fentanyl, worsening withdrawal symptoms, increased inpatient admissions, and expansion of MOUD to community sites. Cost-effective strategies are needed to continue these programs.