Presentation (CTI)

OBJECTIVES: Almost 50% of privately insured individuals with opioid use disorder (OUD) are not receiving medications for OUD (MOUD). The emergency department (ED) is a major point of contact between people living with OUD and the healthcare system. The objectives of this study were to assess the prevalence of MOUD administration in the ED and examine the predictors of MOUD initiation at the ED.
METHODS: The electronic health record of a large academic medical center was queried for records of patients with a diagnosis of OUD who visited the ED between April 2020 and December 2024. Patient characteristics were summarized with descriptive statistics. To assess predictors of initiation or administration of MOUD at the ED, we built a logistic regression model using sex, race, ethnicity, insurance status, language, housing status, hospital admission within 90 days, and ED visit within 90 days.
RESULTS: Of 929 unique patient encounters, 465 (54.4%) were initiated or given MOUD at the ED. According to the logistic regression results, being female (OR =1.53; 95% CI, 1.10 - 2.11), white (OR = 1.50; 95% CI, 1.05 - 2.13), homeless (OR = 1.49; 95% CI, 1.07 - 2.09), possessing insurance (OR = 4.48; 95% CI, 1.59 - 12.62), and number of past hospitalizations (OR = 1.07, 95% CI, 1.01 - 1.12) were associated with increased odds of MOUD initiation or administration. Patient-directed discharge was associated with a lower likelihood of receiving MOUD at the ED (OR = 0.634, 95% CI, 0.42 - 0.95).
CONCLUSIONS: Over half of patients with OUD presenting to the ED received MOUD, indicating progress but highlighting gaps in access. Patient characteristics, social determinants of health, and patient-directed discharge significantly influenced initiation, indicating the need for targeted interventions and integrated models of care to ensure equitable access.