JMIR Publications

ABSTRACT

Background:

The opioid epidemic has disproportionately impacted areas in the Appalachian regions of the United States (U.S.). Characterized by persistent Medicaid non-expansion, higher poverty rates, and healthcare access challenges, populations residing in these areas of the U.S. have experienced higher opioid overdose death rates than other parts of the country. Jefferson County, Alabama, located in Southern Appalachia, has been especially affected, with overdose rates over two times greater than the statewide average (48.8 versus 19.9 overdoses per 10,000 persons). Emergency Departments (EDs) have been recognized as a major source of healthcare for persons with Opioid Use Disorder (OUD). A program to initiate medications for OUD (MOUD) in the ED has been shown to be effective in treatment retention. Likewise, continued patient engagement in a recovery or treatment program after ED discharge has been shown to be efficacious for long-term treatment success.

Objective:

This protocol outlines a framework for ED-initiated MOUD in a resource-limited region of the U.S., made possible through community partnerships with referral resources for definitive OUD care.

Methods:

When a patient presents to the ED with symptoms of opioid withdrawal, non-fatal opioid overdose, or requesting opioid detoxification, clinicians will consider the diagnosis of OUD using the Diagnostic and Statistical Manual of Mental Disorders-5 criteria. All patients meeting diagnostic criteria for moderate to severe OUD will be further engaged and assessed for study eligibility. Recruited subjects will be evaluated for signs and symptoms of withdrawal, treated with buprenorphine/naloxone as appropriate, and given a prescription for take-home induction along with an intranasal naloxone kit. At the time of ED discharge, a peer navigator from a local substance use coordinating center will be engaged to facilitate patient referral to a regional substance abuse coordinating center for longitudinal addiction treatment.

Results:

This project is currently ongoing. It was funded in February, 2019 and approved by the Institutional Review Board at the University of Alabama at Birmingham in June, 2019. Data collection began on July 7th, 2019 with a projected end date of February, 2022. Seventy-nine subjects have been enrolled to date. Results will be published in the summer of 2022.

Conclusions:

ED recognition of OUD accompanied by buprenorphine/naloxone induction and referral for subsequent long-term treatment engagement have been shown to be components of an effective strategy for addressing the ongoing opioid crisis. Establishing community and local partnerships, particularly in resource limited areas, are crucial for the continuity of addiction care and rehabilitation outcomes.