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Rural Health Information Hub

Emergency Department Initiation Model

The emergency department (ED) is a setting that can identify high-risk patients in need of treatment for opioid use disorder (OUD). Emergency providers can begin medication for opioid use disorder (MOUD) for individuals who may come to the emergency department seeking treatment for substance use disorder, complications caused by the substance use, or other medical conditions. The ED is an important initiation point for treatment because some individuals will only seek healthcare services at the ED.

Providers in the ED can use SBIRT or other screening tools, such as the Brief Negotiation Interview, to determine whether patients meet criteria for MOUD. The primary goal of screening patients in the ED is to initiate MOUD and refer the patient to another setting — typically office-based opioid treatment (OBOT) — for continued treatment. Some patients may need a “bridge” clinic to help stabilize treatment before moving to primary care or other treatment setting. Using ED initiation can help remove logistical barriers some rural patients face in accessing medication and treatment for OUD.

Examples of ED Initiation Programs

  • The CA Bridge program began in 2018 and works to increase access to medication for treating opioid use disorder by initiating patient involvement in treatment in the ED. The program treats an average of 1,000 patients each month across California.

Implementation Considerations

Rural programs will need to address several common barriers to MOUD to ensure success of ED initiation of treatment, including waiver limits; provider knowledge, attitudes, and beliefs; and stigma. To ensure medication is initiated, EDs may need to encourage more providers to obtain the DATA 2000 waiver for prescribing. To address stigma, rural MOUD programs may need to provide information and training to emergency providers on several topics, including appropriate terminology for substance use disorders and treating OUD as a chronic illness.

Rural programs will need to work closely with hospitals to garner support for ED initiation of MOUD. In particular, champions within the ED should be identified to foster support for and facilitate patient referrals. Programs may also need to establish formal or informal agreements to facilitate referrals and ensure patients continue treatment after the ED.

Program Clearinghouse Examples

Resources to Learn More

Use of Medication-Assisted Treatment in Emergency Departments
Investigates the available information on emerging and best practices for introducing medication-assisted treatment (MAT) in emergency department (ED) settings. Evaluates the science and current literature on MAT, identifies gaps in knowledge, and discusses the challenges with MAT implementation.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA) Date: 1/2021