Emergency department patients with untreated opioid disorder: A comparison of those seeking versus not seeking referral to substance use treatment.
Little is known regarding the sociodemographic and clinical characteristics of emergency department (ED) patients with untreated opioid use disorder (OUD) and the relationship of those characteristics with whether they were seeking a referral to substance use treatment at the time of their ED visit.
Using data collected from 2/2017 – 1/2019 from participants enrolled in CTN Project ED Health (CTN-0069), researchers conducted a cross-sectional analysis of patients with untreated moderate to severe OUD presenting to one of four EDs in Baltimore, New York City, Cincinnati, or Seattle. Sociodemographic and clinical correlates, and International Classification of Diseases Tenth Revision (ICD-10) diagnosis codes related to opioid withdrawal, injection-related infection, other substance use, overdose, and OUD of those seeking and not seeking a referral to substance use treatment on presentation were compared using univariate analyses.
Among 394 study participants, 15.2% came to the ED seeking a referral to substance use treatment. No differences in age, gender, education, health insurance status, or housing stability were detected between those seeking and not seeking referral to substance use treatment. Those seeking a referral were less likely to have urine toxicology testing positive for amphetamine (17% vs. 31%) and methamphetamine (23% vs. 40%), but more likely to test positive for cocaine (56.7% vs. 42.5%), fentanyl (65% vs. 48.8%), and morphine (93.3% vs. 81.4%), compared to those not seeking a referral.
Conclusions: Most patients with untreated OUD seen in the ED are not there to seek a referral to substance use treatment. Those seeking a referral were less likely to have a urine toxicology test positive for amphetamines/methamphetamines and to be white; they were more likely to have urine toxicology testing positive for cocaine, fentanyl, or morphine. Study findings also suggest a disparity between the presence of OUD and the incorporation of ICD diagnoses for OUD into the electronic medical record in ED patients. Active motivational enhancement, treatment initiation, and coding may improve ED efforts to address untreated OUT and expand access to effective medication for OUD treatment.
Related protocols: CTN-0069