Emergency department–based efforts to offer medication treatment for opioid use disorder: What can we learn from current approaches?

Abstract

Background: The opioid epidemic remains a public health crisis and most people with opioid use disorder (OUD) do not receive effective treatment. The emergency department (ED) can be a critical entry point for treatment. EDs are developing and implementing ED-based efforts to address OUD to improve access to OUD treatment. This study's objective is to identify features of ED-based OUD treatment programs that relate to program implementation, effectiveness, and sustainability. Methods: We obtained data through literature review and semistructured interviews with ED physicians and leaders. The study analyzed these data to develop a framework of key components of ED-based efforts and highlight barriers and facilitators to implementation and program effectiveness. Results: We identify five key features of ED-based opioid treatment programs that vary across programs and may influence effectiveness and impact: patient identification methods; treatment approaches; program structure; relationship with community partners; and financing and sustainability. Successful implementation of ED-based OUD treatment includes having a champion, a reliable referral network, and systematic tracking and reporting of data for monitoring and feedback. Conclusion: Going forward, attention to these features may help to improve effectiveness. As researchers conduct studies of ED-based care models, they should assess the impact of variation in key features to improve program effectiveness.