Change in opioid policies in New England emergency departments, 2014 vs 2018. (1st August 2020)

• Record Type: Journal Article
• Authors: 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.; Camargo, Carlos A.
• Is Part Of: Drug and alcohol dependence. Volume 213(2020)
• Publication Date: 2020-08-01
• Subjects: Opioid -- Prevention -- Treatment -- Policies -- New England; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2020.108105
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Five of six evidence-based opioid-related ED policies increased from 2014 to 2018. The greatest increase was in a policy to prescribe or dispense naloxone. In 2018, a policy to promote accessing the PDMP was most common. In 2018, a policy to promote prescribing/dispensing buprenorphine was least common. 2018 naloxone and buprenorphine practices varied considerably across EDs. Abstract: 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.