Emergency department screening and interventions for substance use disorders

Hawk, Kathryn; D’Onofrio, Gail

doi:10.1186/s13722-018-0117-1

Cited by 137 publications

(109 citation statements)

References 50 publications

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“…Further, because patients with complications from opioid use disorders frequently access EDs for care, the ED may be an ideal venue in which to provide interventions aimed at reducing opioid-related harms (e.g., overdose). 38 …”

Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample

Dora‐Laskey

Goldstick

Arterberry

et al. 2020

WestJEM

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Introduction Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment. Methods Participants (aged 25–60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use. Results Among participants completing the screening survey (n = 756; mean age = 42.8 [standard deviation {SD} =10.4]), 37.8% reported past three-month prescription opioid use (30.8% of whom used daily), and 14.7% reported past three-month DAPO. Of screened participants, 22.5% (n = 170) were eligible for the extended study survey. Unadjusted analyses demonstrated that participants reporting DAPO were more likely to use opioids daily (51.1% vs 15.9%) and had higher rates of opioid misuse (mean Current Opioid Misuse Measure score 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]) chronic pain (80.7% vs 42.7%), and driving after marijuana or alcohol use (mean intoxicated driving score 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]) compared to patients not reporting DAPO (all p<0.001). Adjusting for age, gender, employment, and insurance in a logistic regression model, participants reporting DAPO were more likely to report a chronic pain diagnosis (odds ratio [OR] = 3.77, 95% confidence interval [CI], 1.55–9.17), daily opioid use (OR = 3.81, 95% CI, 1.64–8.85), and higher levels of intoxicated driving (OR = 1.62, 95% CI, 1.07–2.45). Alcohol and marijuana use, depression, and opioid misuse were not associated with DAPO in adjusted analyses. Conclusion Nearly one in six adult patients seeking ED care reported DAPO. The ED may be an important site for interventions addressing opioid-related drugged driving.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample

Dora‐Laskey

Goldstick

Arterberry

et al. 2020

WestJEM

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“…The logic underlying this approach is that, given it is a frequent point of contact people living with OUD have with the formal healthcare system (Masson et al, 2002;Mor, Fleishman, Dresser, & Piette, 1992;Sohler et al, 2007), the ED is in a unique position to identify, develop, and implement solutions to improve outcomes for this population (Anderson, Hsieh, & Alter, 2016;Duber et al, 2018). There is indeed burgeoning evidence supporting ED-based interventions for OUD (Hawk & D'Onofrio, 2018), as prior studies have demonstrated feasibility of and patient receptiveness to opioid education and naloxone distribution (Dwyer et al, 2015) and positive outcomes for patients who begin buprenorphine treatment within the ED setting (Berg et al, 2007;D'Onofrio et al, 2017D'Onofrio et al, , 2015Johns, Bowman, & Moeller, 2018). Separate literature demonstrates promising and growing evidence that peers can improve recovery-oriented outcomes for OUD (Bassuk, Hanson, Greene, Richard, & Laudet, 2016;Reif et al, 2014), and these improvements are largely viewed as an effect of peers' ability to better connect with patients than clinicians who do not have lived recovery experience (Powell, Treitler, Peterson, Borys, & Hallcom, 2019;Salzer, 2002;White & Evans, 2014).…”

Section: Introductionmentioning

confidence: 99%

Replication of an emergency department-based recovery coaching intervention and pilot testing of pragmatic trial protocols within the context of Indiana's Opioid State Targeted Response plan

Watson

Brucker

McGuire

et al. 2020

Journal of Substance Abuse Treatment

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Solving the opioid crisis requires immediate, innovative, and sustainable solutions. A number of promising strategies are being carried out by U.S. states and territories as part of their Opioid State Targeted Response (STR) plans funded through the 21st Century Cures Act, and they provide an opportunity for researchers to assess effectiveness of these interventions using pragmatic approaches. This paper describes a pilot study of Project Planned Outreach, Intervention, Naloxone, and Treatment (POINT), the intervention that served as the basis for Indiana's STR-funded, emergency department (ED)-based peer specialist expansion that was conducted in preparation for a larger, multisite pragmatic trial. Through the pilot, we identified, documented, and corrected for challenges encountered while implementing planned study protocols. Per the project's funding mechanism, the ability to move to the larger trial was determined by the achievement of 3 milestones: (1) successful replication of the intervention; (2) demonstrated ability to obtain the necessary sample size; and (3) observe a higher level of engagement in medication for addiction treatment in the POINT group compared to standard care. Overall implementation of the study protocols was successful, with only minor refinements to proposed procedures being required in light of challenges with (1) data access, (2) recruitment, and (3) identification of the expansion hospitals. All three milestones were reached. Challenges in implementing protocols and reaching milestones resulted in refinements that improved the study design overall. The subsequent trial will add to the limited but growing evidence on ED-based peer supports. Capitalizing on STR efforts to study an already scaling and promising intervention is likely to lead to faster and more sustainable results with greater generalizability than traditional, efficacy-focused clinical research.

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“…Persons with OUD who experience an overdose on injected opioids may end up in the emergency room [14][15][16][17]. This creates an opportunity for change and makes this one potential route of buprenorphine induction.…”

Section: Introductionmentioning

confidence: 99%

Routes of non-traditional entry into buprenorphine treatment programs

Champagne‐Langabeer

Swank

Langabeer

2020

Subst Abuse Treat Prev Policy

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Background: Excessive prescribing, increased potency of opioids, and increased availability of illicit heroin and synthetic analogs such as fentanyl has resulted in an increase of overdose fatalities. Medications for opioid use disorder (MOUD) significantly reduces the risk of overdose when compared with no treatment. Although the use of buprenorphine as an agonist treatment for opioid use disorder (OUD) is growing significantly, barriers remain which can prevent or delay treatment. In this study we examine non-traditional routes which could facilitate entry into buprenorphine treatment programs. Methods: Relevant, original research publications addressing entry into buprenorphine treatment published during the years 1989-2019 were identified through PubMed, PsychInfo, PsychArticles, and Medline databases. We operationalized key terms based on three non-traditional paths: persons that entered treatment via the criminal justice system, following emergencies, and through community outreach. Results: Of 462 screened articles, twenty studies met the inclusion criteria for full review. Most studies were from the last several years, and most (65%) were from the Northeastern region of the United States. Twelve (60%) were studies suggesting that the criminal justice system could be a potentially viable entry route, both pre-release or post-incarceration. The emergency department was also found to be a cost-effective and viable route for screening and identifying individuals with OUD and linking them to buprenorphine treatment. Fewer studies have documented community outreach initiatives involving buprenorphine. Most studies were small sample size (mean = < 200) and 40% were randomized trials. Conclusions: Despite research suggesting that increasing the number of Drug Addiction Treatment Act (DATA) waived physicians who prescribe buprenorphine would help with the opioid treatment gap, little research has been conducted on routes to increase utilization of treatment. In this study, we found evidence that engaging individuals through criminal justice, emergency departments, and community outreach can serve as non-traditional treatment entry points for certain populations. Alternative routes could engage a greater number of people to initiate MOUD treatment.

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Emergency department screening and interventions for substance use disorders

Cited by 137 publications

References 50 publications

Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample

Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample

Replication of an emergency department-based recovery coaching intervention and pilot testing of pragmatic trial protocols within the context of Indiana's Opioid State Targeted Response plan

Routes of non-traditional entry into buprenorphine treatment programs

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