Emergency engagement for opioid use disorder: subjective measures of health and wellness following a warm hand-off in emergency departments

ABSTRACT

Objectives

This study describes an emergency department (ED)-based intervention for individuals with opioid use disorder (OUD) in an urban health system. The intervention utilized electronic health records to screen for OUD and implemented warm hand-offs using certified recovery specialists (CRS). The intervention also encouraged physicians to become certified to prescribe buprenorphine.

Methods

We surveyed individuals using the Center for Substance Use Treatment Government Performance and Results Act (GPRA) survey. 302 individuals were surveyed at baseline on self-reported drug use, quality of life, and health care utilization, and 53 completed a reassessment at three or six-month intervals. Differences in outcomes were assessed using pairwise t-tests at the 95% level of significance.

Results

Participation in the intervention was associated with a reduction in self-reported drug use and reductions in inpatient care. While we found an increase in quality of life, there were also increases in reports of “any depression.”

Conclusion

Better screening, warm hand-offs, and buprenorphine prescriptions in the ED can improve outcomes for individuals with OUD. Lessons learned include challenges reassessing individuals with OUD, the importance of supporting ED staff with buprenorphine training and CRS, and the possibility that depressive symptoms may emerge and worsen as individuals with OUD seek treatment.

KEYWORDS:

• Opioid use disorder
• emergency department opioid screening
• certified recovery specialists
• peer services
• warm hand-off

Acknowledgments

This study was funded by the Substance Abuse and Mental Health Services Administration. The study’s sponsors were not involved in the design or conduct of this study, the preparation of this manuscript, or the decision to submit this manuscript for publication. This study was approved by the University of Pennsylvania’s IRB.

Disclosure statement

The authors report no financial or personal conflicts of interest.

Additional information

Funding

This study was funded by the U. S. Substance Abuse and Mental Health Services Administration by grant number 1H79T1081596-01.