Why Aren’t More Emergency Departments Using Medications for OUD Treatment?
Barriers may be hampering the use of medications for opioid use disorder (MOUD) in US emergency departments (EDs), according to results from a systematic review published in the Journal of Substance Use & Addiction Treatment.
“Patients with opioid use disorder experiencing withdrawal or nonfatal overdose often present to EDs,” wrote a team from the Northwestern University Feinberg School of Medicine, Chicago, Illinois. “While professional societies endorse the initiation of evidence-based MOUD in the ED, low uptake persists.”
The review included 27 peer-reviewed studies with quantitative, qualitative, or mixed methods approaches that focused on MOUD implementation in US EDs. Study outcomes included MOUD acceptability in 11 studies, adoption in 21 studies, appropriateness in 7 studies, feasibility in 4 studies, fidelity in 3 studies, and penetration and sustainability in 2 studies each.
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Physician comfort levels with MOUD varied, although they considered MOUD acceptable, according to the findings. While MOUD adoption rates were frequently low, implementation strategies could improve uptake.
The review also found that ED time constraints and overcrowding could worsen with MOUD and hinder the intervention’s appropriateness in the setting.
“There may be opportunities to overcome these implementation barriers,” researchers wrote, “using multi-component strategies consisting of educational interventions that address safety and monitoring and process interventions, such as clinical decision support systems.”
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