Emergency department interventions for opioid use disorder: A synthesis of emerging models

Thomas, Cindy Parks; Stewart, Maureen T.; Tschampl, Cynthia A.; Sennaar, Kumba; Schwartz, Daniel; Dey, Judith

doi:10.1016/j.jsat.2022.108837

Cited by 9 publications

(4 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interpreted in the context that one in 11 ED visits are made by people with substance use disorders [ 3 ], ED screening may capitalize on crucial opportunities to identify high-risk individuals who may not present elsewhere to the healthcare system. In addition to brief intervention and referral [ 54 ], emerging evidence supports the feasibility and effectiveness of ED treatment initiation (e.g., naltrexone for alcohol use disorder, buprenorphine/naloxone for opioid use disorder, linkage to urgent follow-up and community services [ 55 – 57 ]. The use of accurate screening tools will likely increase the number of patients who are initiated on such treatments in the ED.…”

Section: Discussionmentioning

confidence: 99%

Screening for harmful substance use in emergency departments: a systematic review

Moe,

Koh,

et al. 2024

Int J Emerg Med

View full text Add to dashboard Cite

Background Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use. Methods We included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results. Results Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82–85% and specificities 70–77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies’ risk of bias were mostly high or uncertain. Conclusions Six screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized.

show abstract

Section: Discussionmentioning

confidence: 99%

Screening for harmful substance use in emergency departments: a systematic review

Moe,

Koh,

et al. 2024

Int J Emerg Med

View full text Add to dashboard Cite

show abstract

“… 29 , 31 Programs may further vary in the challenges they face in implementing PRSSs and the diverging experiences of peers working in hospital settings. Implementation issues highlighted in prior research include high turnover, 43 lack of program champions, 29 , 44 and difficulties integrating peers into hospital hierarchical structures. 45 , 46 As reported by peers in qualitative studies, challenges interfering with service delivery include role confusion, 47 health care practitioner stigma, 45 low awareness of peers’ roles, 48 inadequate training and supervision, 47 , 48 and burnout due to the work’s irregular schedule and emotionally taxing nature.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose

Treitler,

Crystal,

Cantor

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportancePatients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department–based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking.ObjectiveTo examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization.Design, Setting, and ParticipantsThis intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023.ExposureHospital OORP implementation.Main Outcomes and MeasuresThe primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access.ResultsA total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (−0.086; 95% CI, −0.154 to −0.018) and 5 half-years (−0.106; 95% CI, −0.184 to −0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities.Conclusions and RelevanceIn this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.

show abstract

“…Recommendations include administering and prescribing MOUD before discharge, using bridge programs to connect to a home for ongoing treatment, and use of peer support to decrease stigma and activate patient engagement. 30,31 To promote a comprehensive approach to opioid stewardship that is consistent across departments and institutions, it is important to standardize key stewardship elements. In our study, we assessed implementation of 11 elements that were supported by the literature, reviewed by subject matter experts, and aligned with National Quality Forum recommendations.…”

Section: Discussionmentioning

confidence: 99%

Opioid stewardship program implementation in rural and critical access hospitals in Arizona

Brady,

SantaMaria,

Tucker Ortiz y Pino

et al. 2024

J of Opioid Management

View full text Add to dashboard Cite

Objective: The objective of this study is to examine rural hospitals' status in implementing opioid stewardship program (OSP) elements and assess differences in implementation in emergency department (ED) and acute inpatient departments. Design: Health administrator survey to identify the number and type of OSP elements that each hospital has implemented. Setting: Arizona critical access hospitals (CAHs). Participants: ED and acute inpatient department heads at 17 Arizona CAHs (total of 34 assessments). Main outcome measures: Implementation of 11 OSP elements, by department (ED vs inpatient) and prevention orientation (primary vs tertiary). Results: The percentage of implemented elements ranged from 35 to 94 percent in EDs and 24 to 88 percent in acute care departments. Reviewing the prescription drug monitoring program database and offering alternatives to opioids were the most frequently implemented. Assessing opioid use disorder (OUD) and prescribing naloxone were among the least. The number of implemented elements tended to be uniform across departments. We found that CAHs implemented, on average, 67 percent of elements that prevent unnecessary opioid use and 54 percent of elements that treat OUD. Conclusions: Some OSP elements were in place in nearly every Arizona CAH, while others were present in only a quarter or a third of hospitals. To improve, more attention is needed to define and standardize OSPs. Equal priority should be given to preventing unnecessary opioid initiation and treating opioid misuse or OUD, as well as quality control strategies that provide an opportunity for continuous improvement.

show abstract

Emergency department interventions for opioid use disorder: A synthesis of emerging models

Cited by 9 publications

References 25 publications

Screening for harmful substance use in emergency departments: a systematic review

Screening for harmful substance use in emergency departments: a systematic review

Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose

Opioid stewardship program implementation in rural and critical access hospitals in Arizona

Contact Info

Product

Resources

About