Substance use: A social emergency medicine perspective

Abstract

While substance use and substance use disorders (SUDs) are increasing in prevalence and severity throughout the United States, a minority of people with SUDs are in formal treatment. The ED is a key site of medical care for patients with SUDs and presents an important opportunity for SUD treatment initiation and linkage to care. Even in a brief clinical encounter, emergency clinicians can have a meaningful impact on patients' lives through SUD screening and identification, provision of harm reduction services, initiation of and linkage to SUD treatment, and linkage to services to address unmet health-related social needs. SUDs have complex biopsychosocial components and a bidirectional relationship with social determinants of health. Therefore, a comprehensive approach to SUDs must include addressing health-related social needs. Partnering with community organizations, specialty societies, and policy makers, EDs and hospitals can work to address social determinants of health which are related to harmful substance use and present barriers to treatment initiation and retention. In this chapter, we describe a social emergency medicine approach to caring for people with SUDs in the ED, highlight model ED and health system initiatives to address SUD and social determinants of substance use, and outline key structural and social determinants of SUDs.