By Jonathan Springston, Editor, Relias Media
A group of investigators have observed a four-fold increase in the number of Indiana patients presenting to emergency departments (ED) seeking treatment for opioid use disorder (OUD).
The authors analyzed the records (including community traits, prescription history, and insurance status) of more than 9,000 patients who sought treatment at four different Indiana health system EDs for OUD. The incidence of repeat opioid-related emergencies went from 8.8% of all opioid-related visits in 2012 to 34.1% in 2017. Documented heroin use, documented previous opioid-related visits, and presenting with Medicaid or as self-pay were just some of the common patient characteristics the authors observed.
“Emergency departments are vital partners in treatment for opioid disorders. Less frequently discussed is the value of emergency department data that can be applied to predict and prevent emergencies among at-risk patients,” Casey P. Balio, PhD candidate at IU Richard M. Fairbanks School of Public Health at IUPUI and lead study author, said in a statement. “Because the ED is such an important site for care, we need to identify opportunities for treatment and support that help increase efficiency across systems of care and benefit patients.”
Bringing emergency physicians on board with the idea of initiating patients on medication-assisted treatment (MAT) for OUD can present challenges. As reported in the March 2020 issue of ED Management, Arnot Ogden Medical Center (AOMC) in Elmira, NY, provides buprenorphine to patients who present with opioid withdrawal symptoms and refers them a local treatment center for continued care. AOMC residents are enthusiastic about this policy, and other physicians are coming around to the idea, especially after learning more about the safety and efficacy of buprenorphine.
Because AOMC is in a smaller community, medical providers must find ways to care for patients with fewer resources. For OUD treatment, AOMC leaders tested their buprenorphine plus community partner referral approach for 12 months between March 2018 and March 2019. Out of 62 patients who were evaluated for the program in the AOMC ED, 53 met the criteria to receive buprenorphine in the ED and were initiated on treatment. Of this group, 46 were compliant with their initial appointment to receive MAT at the addiction treatment clinic. Forty-three of the original 62 patients who were referred to the treatment center for care still were receiving MAT at 30 days, and 33 patients still were engaged in MAT at 90 days.
There were some logistical hurdles; however, other than for data tracking and collection, AOMC’s project did not require additional staff members, especially important for small facilities working with limited resources.