Medications proven to effectively treat opioid addiction are rarely given after emergency department visits for overdose. Where they are prescribed, to which group varies depending on race, ethnicity or geography.
University of Michigan researchers analyzed Medicaid claims from all 50 states and Washington, D.C., between 2016-2020. The researchers found that a mere 6% of patients being treated for overdoses, or about 1 in 16, started treatment with any of the three medications for opioid use disorder within 30 days of leaving the hospital.
“The emergency department offers a critical window of time to initiate medication for opioid use disorder (MOUD). It’s critical because we know that patients who are discharged from the emergenct department (ED) after a nonfatal opioid overdose are at increased risk of experiencing a fatal overdose within the next twelve months,” said Thuy Nguyen, assistant professor of health management and policy at the U-M School of Public Health and founder and director of the Michigan-Substance Use Policy and Economic Research Network.
According to the study the most stark difference in treatment was seen in race with 7.3% of white patients receiving medication to begin treatment for opioid use disorder compared to 4.3% of Black patients, 5.2% of Asian patients, 5.4% of American Indian and Alaska Native patients and 4.9% of Hispanic patients. The study was based on a sample of 249,735 emergency department visits involving 214,101 patients ages 15-64 years old.
The study also broke down differences in which specific drugs were prescribed, buprenorphine, methadone or extended-release naltrexone, within 30 days of discharge from emergency department visits for overdose and also sorted patient demographics by geography and race/ethnicity.
Among the 249,735 visits used in the study, 69% were for white patients, 17.7% were for Black patients, 10% were for Hispanic patients, 2.1% were for American Indian and Alaska Native patients, 0.6% were for Asian patients and 0.5% were for patients of another race. Of the visits, 4.7% were associated with claims for buprenorphine, 1% with methadone claims and 0.8% of claims for extended-release naltrexone.
Opioid overdoses, including synthetic opioids such as fentanyl, took approximately 81,000 lives in the U.S. in 2023, a decrease of about 2,000 deaths from the prior year and the first downturn in all drug overdoses since 2018, according to provisional data from the U.S. Centers for Disease Control Prevention.
However, overdose deaths and opioid addiction remain a major public health concern that harms families and friends and also negatively impacts communities and economies by taxing social services, law enforcement agencies and health care systems. Medicaid is the largest payer of substance use disorder treatment in the U.S., covering about 38% of nonelderly adults with opioid use disorder as of 2019.
Increasing the initiation of opioid addiction medications in the emergency department could also benefit hospitals by preventing patients, many of whom have no primary care doctor, from returning to the ED for another overdose, thus reducing the strain on an already overwhelmed system.
The study appears in the journal Health Affairs and it is titled “Medicaid Patients With ED Visits For Overdose: Disparities In Initiation Of Medications For Opioid Use Disorder”.
