Identifying Barriers to OUD Treatment Linkage From the Emergency Department to the Community

Abstract

Associated with illicitly manufactured fentanyl and its analogues, the current opioid overdose epidemic is the largest recorded in US history. 1 Emergency departments (ED) are essential sites of care for people with opioid use disorder (OUD) and present an opportunity to initiate medications for OUD, including buprenorphine. ED-initiated buprenorphine combined with a follow-up appointment and buprenorphine prescription increases OUD treatment engagement and decreases selfreported illicit opioid use. 2 A recent study by Hawk et al 3 of ED practitioners identified a lack of training or experience with buprenorphine, concerns about availability of outpatient follow-up, and competing needs and priorities for ED resources as barriers to ED-initiated buprenorphine. However, ED practitioners also reported a willingness to initiate buprenorphine with education and training and with availability of local protocols to initiate buprenorphine and pathways to link patients to ongoing OUD care. 3 Addressing and reducing these barriers is imperative to improve ED-initiated buprenorphine and OUD treatment referral. Although ED-initiated buprenorphine is the first step to support patients experiencing opioid withdrawal and to treat OUD, ongoing OUD treatment engagement is necessary to reduce overdose mortality. 4 Thus, building referral pathways between local ED and community OUD treatment practitioners is crucial to ensure that people initiated on buprenorphine in the ED can continue to receive buprenorphine to support their recovery.