JMIR Publications

ABSTRACT

Background:

In 2017, the U.S. Department of Health and Human Services declared a national opioid crisis. In 2022, an estimated 81,806 overdose deaths involved an opioid. Emergency departments are critical in the pathway of care for providing resources and linkages to services. Studies investigating emergency medicine (EM) physicians’ perspectives on the opioid crisis have largely focused on prescribing.

Objective:

To investigate emergency medicine (EM) physicians’ perspectives on response strategies to the opioid crisis of biosurveillance and linkages to care. A secondary objective is to map their reported challenges and recommendations in a sequential intercept model (SIM) as an actionable framework.

Methods:

This is a qualitative study. Six EM physicians in an academic health care system were interviewed through semi-structured interviews. Interviews were transcribed then thematically coded and analyzed to identify cross-sector settings and barriers to care with corresponding recommendations. Settings and recommendations were mapped as a SIM.

Results:

EM physicians identified nine key settings as crucial touch points in the opioid crisis: home setting, emergency medical services, patient care, clinically relevant data and information, prescriptions/pain management, pre-discharge coordination, outpatient resources, biosuveillance sample collection, and external partner/administrative environment. Biosurveillance challenges included concern about collecting biological materials for state and regional monitoring, as well as the time burden for sample collection. Linkage to care challenges included social determinants of health and limited outpatient care access. Recommendations were specific to each setting, and included care coordination and fostering cross-sector partnerships. A patient-centered approach and better integration of community resources was emphasized.

Conclusions:

The service delivery culture is of acute and episodic care but needs to more seamlessly address care across its fragmented multi-component complex system. EM physicians face systemic challenges and provided actionable recommendations to promote comprehensive care to patients presenting to the emergency department with opioid-related complaints.