The following is a summary of “Variability in opioid use disorder clinical presentations and treatment in the emergency department: A mixed-methods study,” published in the April 2023 issue of Emergency Medicine by Faude, et al.

The management of opioid use disorder (OUD) in emergency departments (EDs) varies despite evidence for ED-initiated OUD treatment. For a study, researchers sought to investigate the differences in ED-based OUD care based on the patient’s clinical presentation and explore the barriers and facilitators to ED implementation of OUD treatment across scenarios.

The study analyzed treatment outcomes of OUD-related visits at three urban, academic EDs from December 2018 to July 2020, after implementing interventions to increase ED-initiated OUD treatment. The study assessed differences in treatment with medications for OUD (MOUDs) based on the patient’s clinical presentation, such as overdose, withdrawal, and other OUD-related conditions. In addition, the study integrated these data with the results from five focus groups conducted with 28 ED physicians and nurses between January and April 2020 to understand better clinician perspectives on caring for ED patients with OUD.

The study analyzed 1,339 opioid-related visits, of which 265 (20%) were for overdose, 123 (9%) for withdrawal and 951 (71%) for other OUD-related conditions. 23% of patients received MOUDs during their visit or at discharge. The study found that treatment with MOUDs was least common in overdose presentations (6%) and most common in withdrawal presentations (69%, P < 0.001). Buprenorphine was prescribed at discharge in 15% of visits, including 42% of withdrawal visits, 14% of other OUD-related visits, and 5% of overdose visits (P < 0.001). The clinician focus groups highlighted the variation in ED presentations among patients with OUD and identified key aspects necessary for successful treatment initiation, such as perceived patient receptivity, provider confidence, and patient clinical readiness.

The study found that ED-based treatment of OUD differed by clinical presentation, and clinician focus groups identified several areas where targeted guidance or novel approaches might improve current practices. The results highlighted the need for tailored clinical guidance and can inform health system and policy interventions seeking to increase ED-initiated treatment for OUD.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723000104