Researchers: Emergency Providers Missing Chances to Avert Future Opioid Disasters

By Jonathan Springston, Editor, Relias Media

The authors of a recently published analysis expressed concern over their observed rate of prescriptions written for medication-assisted treatment (MAT) after ED visits for opioid overdoses.

Using Symphony Health’s Integrated Dataverse, which includes information from 5,800 hospitals and 70,000 pharmacies, investigators studied the prescription rates for MAT — specifically, naloxone and buprenorphine, which reverse the effects of an opioid overdose. In more than 148,000 ED visits recorded between Aug. 4, 2019, and April 3, 2021, for an opioid overdose, researchers were looking for at least one prescription of either naloxone or buprenorphine issued within 30 days of the initial visit.

Between April 26, 2020, and Oct. 3, 2020, a difficult stretch of the COVID-19 pandemic, investigators found the rate of mean weekly ED visits for opioid overdoses increased almost 24% compared to the period between Aug. 4, 2019, to April 25, 2020. From Oct. 4, 2020, to March 13, 2021, the authors noted the rate of ED visits for opioid overdoses more closely mirrored prepandemic levels, before the rate began climbing again in mid-March 2021.

Throughout the entire 18-month study period, researchers calculated emergency providers prescribed naloxone and buprenorphine within 30 days of an ED opioid overdose visit at a rate of 7.4% and 8.5%, respectively. The authors noted this is one prescription for about every 12 or 13 opioid overdose ED visits, "suggest[ing] that clinicians are missing critical opportunities to prevent opioid overdose-related mortality," the authors wrote.

“Emergency department visits for an opioid overdose are a critical opportunity to prescribe life-saving medications,” Kao-Ping Chua, MD, PhD, lead study author, said in a statement. “Clinicians are missing these opportunities at a time when U.S. opioid overdose deaths have reached record highs.”

The American College of Emergency Physicians (ACEP) pointed to a telling statistic from the work by Chua and colleagues — the fact that although naloxone was prescribed after 7.4% of ED visits, pharmacies only dispensed the MAT after 6.3% of visits. This indicate some patients might not fill their prescriptions; Chua and colleagues suggested putting MAT in patient hands as they are discharged, instead of handing them a prescription to fill on their own outside the facility.

But ACEP pointed to an even bigger problem — the X waiver, which requires clinicians to undergo training and receive permission from the federal government before they can prescribe buprenorphine. Earlier this year, the Biden administration staked a middle ground by easing some X waiver requirements, but there still are stipulations that remain a sticking point with ACEP and others.

For more on this and related subjects, be sure to read the latest issues of ED Management.