Integrating Emergency Care with Population Health

摘要: Opioid-related overdose deaths in the US have increased since the 1990s, and in the 12 months ending June 2023 provisional overdose deaths exceeded 81,000. 1 The emergency department (ED) has been involved in addressing the opioid crisis by implementing opioid-sparing pain management protocols and treating opioid overdoses. Yet patients with non-fatal unintentional opioid overdose visits to the ED are still 100 times more likely to die of an overdose within a year of their index visit than those from a demographically matched population. 2 Emergency departments are in the unique position to initiate and link to evidence-based treatment for opioid use disorder (OUD) when a patient presents acutely with opioid withdrawal or non-fatal overdose.Buprenorphine, a partial opioid agonist, is an effective medication to treat OUD that has historically not been offered in ED settings. In 2015, D’Onofrio et al published a seminal, randomized controlled study demonstrating the efficacy of ED-initiated buprenorphine and ongoing engagement in OUD treatment at 30-days post discharge. 3 Follow-up studies also demonstrated that ED-initiated buprenorphine is an effective intervention, with ongoing OUD treatment at 30 days in 50–86% of the patients. 4, 5 On the heels of these findings, the Substance Abuse and Mental Health Services Administration published a resource guide in 2021 acknowledging the ED as an important site for provision of OUD treatment. 6 In the same year, the American College of Emergency Physicians published consensus recommendations for OUD treatment including use of buprenorphine in the ED. 7 While …