Emergency Department Interventions for Opioid Use Disorder

Emergency departments (EDs) are key partners in filling the gap between people who need opioid use disorder (OUD) treatment and people who ultimately receive it. EDs are uniquely situated to interact with individuals who have experienced an opioid overdose or otherwise have limited interactions with the healthcare system, presenting an opportunity for EDs to serve as an entry point into treatment. ASPE conducted this study to identify innovative models and key characteristics of ED programs that initiate or facilitate engagement in OUD treatment, as well as barriers and facilitators to their implementation and sustainability. Our methods consisted of an environmental scan and case studies of five ED efforts across the United States. We found significant variation in program components, including methods for patient identification, approaches to treatment engagement, structure, relationships with community-based organizations, and financing.

This research was conducted under contract #HHSP233201600012I between HHS/ASPE’s Office of Behavioral Health, Disability, and Aging Policy (BHDAP) and Brandeis University.  Additional research in this area is available at the ASPE Public Health page.

Available Reports:

• Emergency Department Interventions for Opioid Use Disorder: Overview of the Landscape, Key Components, and Analysis of Five Case Studies

Related Resources:

• Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment (2019). Substance use disorders (SUDs) represent a serious public health problem in the United States. Recent attention has focused most on opioid use, including heroin use and prescription opioid misuse, with the attendant high rates of opioid-related overdoses.  Alcohol use disorders are more common than OUDs and also represent a public health concern.  There is, however, evidence-based treatment for both alcohol use disorders and OUDs, although rates of treatment receipt are persistently low. One measure of treatment receipt is the Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) performance measure, which is commonly reported by health plans and used by several Medicare and Medicaid programs. Reported IET results vary significantly between plans. This indicates that some plans are more effective than others at initiating and engaging their members in SUD treatment. This study used NCQA-accredited HEDIS data, which captures at least 75% of health plans, to identify high performing plans on the IET measure to help assess characteristics and interventions associated with better initiation and engagement of SUD treatment by plan members.
• Inpatient Bed Tracking: State Responses to Need for Inpatient Care (2019). States have begun to collect and post information on bed availability (i.e., create bed registries or bed tracking systems) as a tool for providers, patients, and caregivers to identify open beds more efficiently. In the absence of a bed registry, emergency room staff, patients, or other providers must call multiple hospitals or residential settings to determine if there is a slot available that would be appropriate given the patient’s needs. Little is known about states bed registries, their effectiveness, and challenges faced in their execution and utilization. ASPE contracted with RTI to study whether states were making information on open beds available to consumers, the impact of effect that inpatient bed tracking had on patient access, and the challenges that remain with inpatient bed tracking systems. To collect this information, RTI conducted an environmental scan and 13 interviews with 18 stakeholders in 5 states. Through the environmental scan and discussions with stakeholders, the authors found significant variation among states in how the registries were operating, the types of behavioral health providers they included, and perceptions of their usefulness. In some states, systems to track the availability of psychiatric hospital beds have been challenged by the reluctance of hospitals to update information on open beds frequently enough to be useful given rapid patient turnover. ED staff noted that the system does not negate the need for them to call hospitals to confirm that there is still an open bed that is appropriate for the patient’s needs and that relationships among hospitals and EDs and other crisis system staff may be more efficient than using the bed registries. However, some states reported that the registries were very helpful in locating open beds as well as in documenting the need for additional psychiatric beds.
• Non-Fatal Opioid Overdose and Associated Health Outcomes: Final Summary Report (2019). Non-fatal opioid overdose (NFOO) is a significant cause of opioid-related morbidity in the United States. As the number of NFOOs continues to grow, it is important to understand the short and long-term consequences of NFOO. This report examines the existing literature on the acute and chronic health and functional outcomes of individuals who experience NFOO, and also identifies differences in outcomes for NFOOs involving illicitly-manufactured fentanyl.
• State and Local Policy Levers for Increasing Treatment and Recovery Capacity to Address the Opioid Epidemic: Final Report (2017). This report summarizes financing and workforce policies that can be used by states to expand treatment access and capacity for OUD, focusing especially on medication-assisted treatment (MAT). Our evaluation team used a case-study approach and conducted an environmental scan and stakeholder interviews for 5 states: California, Missouri, New Hampshire, Ohio, and Virginia. The results highlight key levers each state is using to expand or improve access to MAT, summarize common themes among financing and workforce policies, and map the policy levers to different settings in which a patient could start MAT, describing ways to build local capacity.
• An Assessment of Innovative Models of Peer Support Services in Behavioral Health to Reduce Preventable Acute Hospitalization and Readmissions (2015). Recurrent psychiatric hospitalizations and ED utilization is common among those with serious mental illness resulting in excessively high health care costs, and preventable overuse of services. Peer support services are a recognized part of team-based care for behavioral health conditions. This study examines peer support service programs and their service models, approaches, and practice methods used to reduce preventable psychiatric hospitalization, re-hospitalization, and ED use. A 3-level framework is presented to illustrate the findings of the study.