Emergency departments (EDs) may be the primary, and sometimes only, connection to the healthcare system for people with opioid use disorder (OUD) or opioid overdose,[1] making them important sites in the continuum of care for OUD. Emergency departments can connect people with OUD to community-based care, particularly through the provision of medications for OUD, such as buprenorphine, as recommended by the American College of Emergency Physicians.[2]
As noted in our previous blogs, both the state of New Jersey and New Jersey hospitals have initiated a range of interventions to address the opioid crisis in their EDs. Our team has been investigating buprenorphine prescribing in NJ EDs to understand the uptake of these interventions across hospitals, the barriers and facilitators to implementation of buprenorphine administration and prescription in the ED, and the characteristics of patients receiving ED buprenorphine.
Analyzing New Jersey Medicaid claims data from 2017 to 2022, we identified opioid-related ED visits for enrollees aged 18-64. Opioid-related ED visits included those with at least one claim with opioid poisoning or OUD diagnosis, and buprenorphine-receiving patients were identified by new buprenorphine prescription fills or dispensing events within zero to four days of their discharge from the ED.
Between 2018 and 2022, there were 24,732 qualifying opioid-related ED visits, with patients receiving buprenorphine during 978, or 4%, of those visits. The provision of buprenorphine in EDs for opioid-related visits increased during this period, from 0.8% to 7.1%. Of the patients receiving buprenorphine, 64.4% were male. Racial and ethnic breakdown of patients who received ED Buprenorphine are provided below in Table 1.
Table 1. Race and ethnicity of Medicaid enrollees aged 18-64 receiving ED buprenorphine between 2018 and 2022
| Race and Ethnicity | No ED Buprenorphine (n = 23,754) | ED Buprenorphine (n = 978) | Total
(n = 24,732) |
| White | 11,412 (96.6%) | 397 (3.4%) | 11,809 |
| Black | 8,017 (95.2%) | 402 (4.8%) | 8,419 |
| Hispanic | 2,957 (95.7%) | 132 (4.3%) | 3,089 |
| Other/Unknown | 1,368 (96.7%) | 47 (3.3%) | 1,415 |
Adequate and equitable access to emergency department buprenorphine is important given increasing rates of opioid overdose and opioid-related hospital visits among Black and Hispanic populations in NJ.[3],[4] A previous study of racial and ethnic disparities in ED buprenorphine in five health systems in the Eastern U.S. (outside NJ) found that Black patients were less likely to receive the medication in the ED.[5] Our early descriptive statistics are not suggestive of similar disparities in NJ hospitals, possibly owing to the fact that ED buprenorphine has been spearheaded by two urban hospital systems that house the state’s Medication Assisted Treatment Centers of Excellence, which predominantly serve Hispanic and Black communities. Promoting the use of evidence-based interventions in hospitals serving minoritized communities could contribute to reducing the long-standing racial and ethnic disparities in the receipt of medications for opioid use disorder.
Our future mixed-methods analyses will contextualize these findings, seeking to better understand the adoption and implementation of initiatives to prescribe buprenorphine in NJ EDs. Our interviews with ED leaders throughout NJ will shed light on the uptake of these initiatives and can inform future efforts to increase ED buprenorphine prescribing across all patient populations.
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] New Jersey Department of Health. New Jersey SUDORS Overdose Mortality Data Explorer, Unintentional Overdose Deaths Over Time. Accessed April 19, 2024. https://www.nj.gov/health/populationhealth/opioid/sudors.shtml
[4] New Jersey Department of Health. Drug-related Hospital Visits (Non-fatal Overdoses). Accessed April 19, 2024. https://www.nj.gov/health/populationhealth/opioid/opioid_hospital.shtml
[5] Holland WC, Li F, Nath B, Jeffery MM, Stevens M, Melnick ER, Dziura JD, Khidir H, Skains RM, D’Onofrio G, Soares III WE. Racial and ethnic disparities in emergency department-initiated buprenorphine across five health care systems. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2023 Jul;30(7):709-720. doi: 10.1111/acem.14668. Epub 2023 Feb 27.