Emergency department–based efforts to offer medication treatment for opioid use disorder: What can we learn from current approaches?

Impact of Universal Screening and Automated Clinical Decision Support for the Treatment of Opioid Use Disorder in Emergency Departments: A Difference-in-Differences Analysis

“…Our findings suggest that universal screening coupled with targeted electronic health record prompts is an effective implementation strategy to increase broader adoption of treatment of opioid use disorder in ED settings that can overcome the numerous barriers to initiation of buprenorphine. 12 , 13 , 41 We leveraged behavioral insights—including the concept of “nudges”—to design clinician electronic health record workflows for the following: (1) make identification of opioid use disorder and active withdrawal the default practice, (2) activate tailored prompts to nurses and physicians in the existing workflow to signal the importance of timely care for opioid use disorder, and (3) navigate clinicians to clinical decision support to make evidence-based treatment easy. Our finding that the largest gains were among low-adopting physicians suggests that the intervention reduced variability by making it easier to deliver evidence-based care.…”

What makes a peer? Characteristics of certified peer recovery support specialists in an emergency department-based intervention

“…Stewart, et al (2021), identified five key features of EDbased interventions for OUD: patient identification; treatment approaches; program structure; relationship with community treatment programs; and program financing, sustainability, and maturity. Peer support services were described as "a key part" of these interventions, however a discussion on the characteristics of the peers themselves was missing [8]. Other studies point to what makes an effective workflow for CPRSS in the ED but not the unique characteristics of the people that make these interventions work [11].…”

“…Therefore, when someone presents to the ED for an OD or a drug-related concern, it is an opportunity to engage them in harm reduction services and link them to substance use disorder (SUD) treatment and other services, if appropriate. The ED has been identified as a crucial point of contact [8], described as both a "teachable" [9] and "reachable" moment [10] for PWUD.…”

“…In part because CPRSS models have been determined to be feasible and acceptable to health care providers working in settings such as the ED [8,11,[25][26][27][28], CPRSS models have been rapidly implemented across the United States in hospital and community settings in response to the escalating opioid OD crisis [11,19,20,27,29]. It has also been shown that people who use opioids are open to and welcome engagement with a CPRSS in a setting such as the ED [16,19].…”