Medications for Opioid Use Disorder: Emergency Department Leaders’ Insights on the Role of Peers

By Kylie Davidson, Cadence F. Bowden, Hannah Shepherd, Peter Treitler, and Stephen Crystal

Emergency departments (EDs) may be the primary, and even only, connection to the healthcare system for significant numbers of people with opioid use disorder (OUD) or opioid overdose,[1] making them important sites of intervention for people with OUD. EDs can serve as a bridge, connecting patients with OUD to long-term outpatient care.[2] As noted in our previous blogs, New Jersey and NJ hospitals have initiated a range of interventions to address the opioid crisis in EDs. Our New Jersey State Policy Lab project examines one such intervention – prescribing buprenorphine, a medication for OUD, in NJ EDs. Drawing on quantitative data alongside interviews with ED leaders, our team seeks to understand clinician perspectives and institutional practices surrounding buprenorphine prescribing in EDs.

Interviews are ongoing, but preliminary analysis offers important insights into the provision of care for people with opioid use disorder and overdose in EDs. Though interviews primarily focus on the prescription of medications for OUD in the ED, we’ve noticed an interesting trend, particularly around the role of peers in supporting this care. Several interviewees described the work of peers – or those with lived experience with substance use – as vital in supporting treatment efforts in their hospitals. Some hospitals reported having in-house peers, whereas others worked with peers from external organizations who respond to the ED as needed.

Among institutions with peers, interviewees discussed the importance of peer specialists in the treatment process. In particular, they highlighted the role peers play in building rapport with patients, connecting patients to community resources, and maintaining contact with patients for post-discharge follow-up.

Our preliminary findings are aligned with existing literature on the promising role of peer support in the treatment of substance use disorders. Prior research conducted by members of this study team and others found increased initiation of medications for opioid use disorder (MOUD) and decreased repeat of medically treated overdoses in EDs that implemented peer support.[3] Our preliminary analysis similarly suggests that peers play an important role in the provision of care in EDs for those presenting with OUD or opioid overdose, though additional data are needed.

As we continue interviews with ED leaders, we aim to further understand the barriers and facilitators to uptake and implementation of initiatives to support people with opioid use disorder in NJ emergency departments. The insights we gain from our mixed-methods study can inform future efforts to improve and build upon OUD care in ED settings across the state.

References

[1] Fox L, Nelson LS. Emergency Department Initiation of Buprenorphine for Opioid Use Disorder: Current Status, and Future Potential. CNS Drugs 2019 Dec;33(12):1147-1154. doi: 10.1007/s40263-019-00667-7.

[2] Hawk J, Hoppe J, Ketcham E, LaPietra A, Moulin A, Nelson L, Schwarz E, Shahid S, Stader D, Wilson MP, D’Onofrio G. Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department. Annals of Emergency Medicine 2021 Sep;78(3):434-442. doi: 10.1016/j.annemergmed.2021.04.023. Epub 2021 Jun 23.

[3] Treitler P, Crystal S, Cantor J, Chakravarty S, Kline A, Morton C, Gilmore Powell K, Borys S, Cooperman NA. Emergency Department Peer Support Program and Patient Outcomes after Opioid Overdose. JAMA Network Open 2024 Mar 4;7(3):e243614. doi: 10.1001/jamanetworkopen.2024.3614.