We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. MethodsThis was a cross-sectional survey study of American emergency medicine (EM) physicians with a selfadministered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. ResultsThere were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). ConclusionBarriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings.

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New York State initiated a micro-cluster strategy ("hot spotting") that divides into three categories based on COVID-19 cases and hospital capacity, each with successively more restrictions: Yellow, Orange, and Red Zones. Our objectives were to evaluate the influence of hot spotting on mobility and subsequent mortality, and then to identify underlying social determinants of health associated with the neighborhoods most affected by hot spotting.Study Design: We combine several data sources in our analysis. Time-dependent data were obtained from SafeGraph for cellphone mobility at the Census Block Group, New York State Governor's Office for hot spotting, school and indoor dining, and NYC Department of Health and Mental Hygiene (DOHMH) for COVID-19 cases and mortality. Using the DOHMH's "Modified Zip Code Tabulation Areas" (MODZCTA), we matched these to community-level data obtained from 2018 American Community Survey 5-year estimates for population density. Our main outcomes are Average Median Percentage Time Home (AMPTH) and Device-Weighted Average Median Percentage Time Home (DWAMPTH) from SafeGraph Social Distancing Metrics summarized to MODZCTA boundaries. Home is defined as the common nighttime location of each mobile device over a 6-week period to a Geohash-7 granularity (w153m x w153m). We implemented the Wilcoxon rank-sum test with a <0.05 p-value threshold for each day since hot spotting policy to compare MODZCTA with any of the Zone's designation to those without designation. Our main outcomes are Average Median Percentage Time Home (AMPTH) and Device-Weighted Average Median Percentage Time Home (DWAMPTH) from SafeGraph Social Distancing Metrics summarized to MODZCTA boundaries.Population Studied: NYC residents from October 5, 2020, to December 31, 2020 (87 days total) using the 177 MODZCTA within NYC as geographic unit of analysis.Results: For the AMPTH measurement, MODZCTAs with hot spotting Zone's designation had 84 days (95% of the days) with statistically significantly lower mobility than non-intervention MODZCTAs, and for the DWAMPTH measurement, 83 days (97% of the days) had statistically significantly lower mobility. 58 of the days had p-value<0.001 for AMPTH and 49 had p-value<0.001 for DWAMPTH, and only a minority of days had p-value>0.1 (2 days for AMPTH and 3 for DWAMPTH). Looking at individual boroughs, Brooklyn had 42 statistically significant days for AMPTH and 49 for DWAMPTH, while Queens had 12 statistically significant days for AMPTH and 7 for DWAMPTH.Conclusions: New York State's micro-cluster focus Zones is associated with decreased mobility in high COVID-19 prevalence areas. Our study suggests that shutdowns targeted at small geographic areas may reduce mobility and thus can potentially help control COVID-19 spread.