Barriers and facilitators in treating opioid addiction in the ER

Every day, news stories depict the staggering toll of the opioid overdose crisis. This is particularly salient in Philadelphia, which has one of the highest overdose death rates among major U.S. cities. Despite effective medications for opioid use disorder, such as buprenorphine and methadone, few people receive treatment. The ongoing challenge is to expand access to these lifesaving treatments to people who need them the most. Emergency departments, which treat patients 24/7 and provide an entry point into the health system, are a promising place to start. 

One recent study showed that after a nonfatal overdose, methadone and buprenorphine treatment were associated with a 50 percent reduction in deaths in the following year. Starting buprenorphine in the emergency department works better than the typical practice of stabilizing and discharging a patient with a treatment referral, more than doubling the rate of treatment engagement at 30 days.

What is not known is how to apply these findings in real-world emergency departments, which are busy places navigating everything from the highest risk trauma patients to those with multiple chronic conditions and no primary care.

Margaret Lowenstein, a general internist and research fellow at Penn, and colleagues surveyed emergency medicine physicians in two Penn Medicine hospitals to understand the barriers and facilitators to starting buprenorphine in the emergency department.

Read more at the Leonard Davis Institute.