Change in opioid policies in New England emergency departments, 2014 vs 2018.
Drug and alcohol dependence
New England, Opioid, Policies, Prevention, Treatment
OBJECTIVE: The U.S. opioid epidemic persists, yet it is unclear if opioid-related emergency department (ED) policies have changed. We investigated: 1) the prevalence of opioid use disorder (OUD) prevention and treatment policies in New England EDs in 2018, and 2) how these policies have changed since 2014.
METHODS: Using the National Emergency Department Inventory-USA, we identified and surveyed all New England EDs in 2015 and 2019 about opioid-related policies in 2014 and 2018, respectively. The surveys assessed OUD prevention policies (to use a screening tool, access the Prescription Drug Monitoring Program [PDMP], notify primary care providers, prescribe/dispense naloxone) and treatment policies (to refer to recovery resources, prescribe/dispense buprenorphine).
RESULTS: Of 194 EDs open in 2018, 167 (86 %) completed the survey. Of 193 EDs open in 2018 and 2014, 147 (76 %) completed both surveys. In 2018, the most commonly-reported policy was accessing the PDMP (96 %); the least commonly-reported policy was prescribing/dispensing buprenorphine to at risk patients (37 %). EDs varied in prescribing/dispensing naloxone: 35 % of EDs offered naloxone to ≥80 % of patients at risk of opioid overdose versus 33 % of EDs to <10 >% of patients at risk. Most EDs (74 %) reported prescribing/dispensing buprenorphine to <10 >% of patients with OUD. Comparing 2018 to 2014, the greatest difference in policy use was in prescribing/dispensing naloxone (+55 %, p < 0.001).
CONCLUSION: Implementation of opioid-related ED policies increased between 2014 and 2018. Continued effort is needed to understand the extent to which policy implementation translates to clinical care, and to best translate evidence-based policies into clinical practice.
Teferi, Maranatha M; Boggs, Krislyn M; Espinola, Janice A; Herrington, Ramsey; Mick, Nathan W; Rutman, Maia S; Venkatesh, Arjun K; Zabbo, Christopher P; Hasegawa, Kohei; Samuels-Kalow, Margaret E; Weiner, Scott G; and Camargo, Carlos A, "Change in opioid policies in New England emergency departments, 2014 vs 2018." (2020). Maine Medical Center. 1838.