Medications that are shown to effectively address opioid dependency are infrequently prescribed following emergency department visits for overdose, with disparities evident based on race, ethnicity, or location, as stated by researchers from the University of Michigan.
In their investigation reviewing all Medicaid claims from all 50 states and Washington D.C. between 2016-2020, the researchers discovered that only 6% of individuals treated for overdoses, or approximately 1 in 16, commenced treatment with any of the three medications for opioid use disorder, or MOUD, within 30 days of hospital discharge.
“The emergency department presents a vital opportunity to initiate MOUD. This timing is crucial because we understand that individuals discharged from the ED after a near-fatal opioid overdose face a heightened risk of a fatal overdose within the subsequent year,” remarked Thuy Nguyen, assistant professor of health management and policy at the U-M School of Public Health, as well as founder and director of the Michigan-Substance Use Policy and Economic Research Network.
As per the study published in Health Affairs, the most pronounced difference in treatment was observed among races, with 7.3% of Caucasian patients receiving medication for initiating treatment for opioid use disorder compared to 4.3% of African American patients, 5.2% of Asian patients, 5.4% of Native American and Alaska Native patients, and 4.9% of Hispanic patients. The analysis was based on 249,735 emergency department visits involving 214,101 patients aged 15-64 years.
The research also detailed variations in the specific medications prescribed, namely buprenorphine, methadone, or extended-release naltrexone, within 30 days following discharge from emergency department visits for overdose and further categorized patient demographics by geography and race/ethnicity.
Among the 249,735 visits utilized in the study, 69% were attributed to Caucasian patients, 17.7% to African American patients, 10% to Hispanic patients, 2.1% to Native American and Alaska Native patients, 0.6% to Asian patients, and 0.5% to patients of other races. Of these visits, 4.7% were associated with buprenorphine claims, 1% with methadone claims, and 0.8% with claims for extended-release naltrexone.
“The disparity between African American and Caucasian patients became even more pronounced during the study period,” Nguyen noted. “This is particularly alarming given that overdose fatalities and emergency visits associated with opioids have been escalating more rapidly among African American patients.”
Opioid overdoses, including synthetic opioids like fentanyl, resulted in approximately 81,000 fatalities in the U.S. in 2023, representing a reduction of around 2,000 deaths from the previous year, marking the first decrease in all drug overdose deaths since 2018, as reported by provisional statistics from the U.S. Centers for Disease Control and Prevention.
Nonetheless, overdose fatalities and opioid dependency continue to pose significant public health challenges that affect families and communities while also placing burdens on social services, law enforcement, and healthcare systems. Medicaid stands as the foremost funder of substance use disorder treatment in the U.S., covering about 38% of nonelderly adults with opioid use disorder as of 2019.
“Numerous factors contribute to the low rates of MOUD initiation in the emergency department, including stigma surrounding opioid dependency, insufficient clinician training on managing this issue, and time constraints,” Nguyen stated. “It is plausible that race and ethnicity serve as proxies for some of these underlying factors, contributing to the disparities in MOUD initiation rates observed in our findings.”
Regionally, the U.S. Northeast exhibited the highest percentage of patients treated for overdose at 8.6%. The Midwest’s rate was 6.5%, contrasting with 5.5% in the South and 5% in the West, where the gap in treatment between African American and Caucasian patients was smallest.
When comparing rural to urban patients, the differences were minimal.
Nguyen and colleagues advocate for healthcare providers to utilize the findings to customize care according to the needs and inequalities affecting various patient groups.
Enhancing the initiation of opioid addiction medications within the emergency department could also aid hospitals by preventing patients, many of whom lack a primary care physician, from returning to the ED for subsequent overdoses, thereby alleviating strain on an already burdened system.
“Acting during the overdose crisis can be advantageous for all involved, in numerous ways,” Nguyen emphasized. “It’s equally essential to consider the patient’s role, adherence, and other challenges to accessing MOUD post-discharge.”
Co-authors of the study, all from U-M, include: Yang (Amy) Jiao, Stephanie Lee, Pooja Lagisetty, Amy Bohnert, Keith Kocher, Kao-Ping Chua.