Emergency Medicine Research Priorities for Early Intervention for Substance Use Disorders

Abstract

Introduction Patients with substance use disorders (SUDs) frequently seek emergency care, and the emergency department (ED) may be their only point of contact with the healthcare system. While the ED visit has been increasingly recognized as providing opportunity for interventions around substance use, many questions remain. Methods In December 2016 the Coalition on Psychiatric Emergencies (CPE) convened the first Research Consensus Conference on Acute Mental Illness, which consisted of clinical researchers, clinicians from emergency medicine, emergency psychiatry, emergency psychology, representatives from governmental agencies and patient advocacy groups. Background literature review was conducted prior to the meeting, and questions were iteratively focused, revised, voted on and ranked by perceived importance using nominal group method. Results The main goal of the SUD workgroup was to identify research priorities and develop a research agenda to improve the early identification of and management of emergency department (ED) patients with SUDs with the goal of improving outcomes. This article is the product of a breakout session on “Special Populations: Substance Use Disorder.” The workgroup identified with high consensus six research priorities for their importance related to the care of ED patients with SUDs in these overall domains: screening; ED interventions; the role of peer navigators; initiation of SUD management in the ED; specific patient populations that may impact the effectiveness of interventions including sociogenerational and cultural factors; and the management of the acutely intoxicated patient. Conclusion Emergency providers are increasingly recognizing the important role of the ED in reducing adverse outcomes associated with untreated SUDs. Additional research is required to close identified knowledge gaps and improve care of ED patients with SUD.

Opportunities for Research in Mental Health Emergencies: Executive Summary and Methodology

“…With regard to substance use, more research is needed on screening and intervention for substance use in the ED 29. Indeed, in the period of time that has elapsed since this conference the director of the National Institute of Drug Abuse has made public comments likening the failure of EDs to provide treatment options to patients with SUD as potential “malpractice.”30 In the psychosis workgroup, better methods for screening, measurement, and evaluation of psychosis are needed.…”

Provider perspectives on emergency department initiation of medication assisted treatment for alcohol use disorder

“…The emergency department visit represents an opportune window to initiate AUD treatment because the ED visit is frequently the only point of contact with the health system for patients with SUD [41]. The ED visit is increasingly recognized as an important point for intervention for patients with SUD [41], and the ED has been shown as an effective venue for MAT programs focused on the treatment of opiate use disorder [8].…”

How Emergency Physicians Approach Refusal of Observation after Naloxone Resuscitation

“…The EPs we interviewed engaged in a variety of strategies to help encourage compliance with observation and to reduce harm. Many of these strategies, such as expressing direct, personal concern for patients' well-being, are rooted in establishing a therapeutic alliance, wellsupported by the addiction medicine literature, and in keeping with the foundational ethical principles of beneficence and respecting autonomy (38)(39)(40). Likewise, a significant number of interviewees expressed interest in providing MAT in the ED or reported that they had already made this part of their practice.…”