Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department

Abstract

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.

Initiation of opioid agonist therapy after hospital visits for opioid poisonings in Ontario

“…A US study showed that only 20.9% of emergency department physicians felt ready to prescribe buprenorphine–naloxone, citing a lack of formal training, limited knowledge of resources and absence of local protocols and referral networks. 17 Other research similarly suggests that barriers to OAT initiated in the emergency department include a shortage of trained prescribers and limited knowledge of outpatient follow-up options; 18 fewer than half of emergency department clinicians felt comfortable initiating methadone. 19 More research is needed to further elucidate the reasons for low OAT prescribing within hospital settings in Ontario, but effective responses may include providing institutional OAT training, establishing OAT initiation protocols in acute care settings, organizing and promoting awareness of referral networks with outpatient addictions programs, 20 and improving prescribing for patient-initiated discharges.…”

At a Crossroads: Opioid Use Disorder, the X-Waiver, and the Road Ahead

“… 87 In a Kentucky study, physicians without an X-Waiver were less likely to report positive personal beliefs about using medications to treat OUD compared to physicians who had an X-Waiver. 88 While the recommendation to include X-Waiver requirements as a part of residency training were proposed in the literature, 89 implementation remained limited.…”

Effect of Didactic Training on Barriers and Biases to Treatment of Opioid Use Disorder: Meeting the Ongoing Needs of Patients with Opioid Use Disorder in the Emergency Department during the COVID-19 Pandemic

“…EM residents are more eager to initiate MAT than attendings, and most consider it very important to have training in buprenorphine initiation [ 17 , 18 ]. Nonetheless, the role of formal training for EM residents in recognizing, administering, and prescribing buprenorphine has not been established and few programs have developed focused curricula on addiction medicine [ 19 ].…”