(20) Emergency Department Utilization for OUD Before and After Receiving Buprenorphine from EMS

Background &

Introduction: As of 2022, it was estimated that over 3% or over nine million people in the United States have opioid use disorder (OUD) (1). With only 11% of these individuals receiving evidence-based care, increasing access to treatment is a priority (2). In 2019, Cooper University Healthcare and its Emergency Medical Services (EMS) program established a new treatment pathway by launching an initiative to administer buprenorphine to patients post-opioid overdoses and linkage to a walk-in specialized substance use clinic. Buprenorphine is a partial agonist medication used to treat OUD and has been shown to be effective in reducing mortality in patients (3). Prompt administration of buprenorphine by a specially trained paramedic improves withdrawal symptoms and engagement in subsequent treatment (3). We investigated ways patients interact with the healthcare system post-buprenorphine administration in the field. Individuals diagnosed with OUD were shown to visit the ED more frequently than non-OUD patients and were more likely to revisit within 72 hours (4). In a secondary analysis, ED utilization of patients who received buprenorphine in the field was examined. We hypothesized that patients who received buprenorphine in the field would increase the number of ED visits 6 months post-buprenorphine administration compared 6-months before administration.

Methods: A retrospective chart review was used to examine the number of ED visits 6-months prior and 6-months after a patient received buprenorphine post-overdose and naloxone resuscitation from Cooper EMS between August 2019 to April 2024. Manual chart review was used to extract variables from the electronic medical record, including demographics, psychiatric diagnoses, chronic medical conditions, number of ED visits and types of ED visits. Emergency room visits were categorized as OUD related, which consists of overdose, withdraw, or treatment maintenance, and non-OUD related. Any discrepancies on how ED visits were categorized was reviewed with an ED physician on the research team. Descriptive statistics were used to characterize participants' demographics, psychiatric diagnoses, chronic medical conditions, number of ED visits and types of ED visits. A Wilcoxon rank sum tests using R base stats package was used to assess whether participants who received buprenorphine in the field had any change in ED visits in the six months following buprenorphine induction, stratifying these differences by whether or not patients had key medical or psychiatric conditions and whether or not they were in MOUD treatment at 30 days.

Results: Of the 292 participants who received buprenorphine from Cooper's EMS the average age was 43.6 (SD ±11.7), 221 (75.5%) were men, 115 (39.4%) were non-Hispanic white. Overall, 36.6% had no history of a psychiatric or chronic medical problem, 19.9 % had a history of psychiatric diagnoses, 17.5% had at least one chronic medical problem, and 17.5% had both a history of psychiatric diagnoses and at least one chronic medical problem. The average number of ED visits in the 6 months prior to EMS encounters was 1 (0, 27) and the average number of visits 6 months after was 1 (0, 102). The change in total ED visits was 0 (-18, 88). The average number of OUD specific ED visits 6 months prior to the EMS encounters was 0 (0, 14) while the average number of OUD specific visits 6 months after was 0 (0, 21). Whereas non-OUD specific ED visits 6 months prior was 0 (0, 19) and 6 months after was 0 (0,101). Of the sample population, 58 (19.9%) were in OUD care at 30 days post-buprenorphine administration, while 216 (74.0%) were not in OUD care at 30 days.

Patients with key chronic medical problem and psychiatric diagnoses had a change in the total number of ED visits in the 6 months after the EMS buprenorphine induction compared to the 6 months prior to EMS buprenorphine induction (median 1.0 increase, V=762.5, p< 0.05). When stratified by OUD-related visits and non-OUD-related visits, only non-OUD-related visits increased in the 6 months after the EMS buprenorphine induction (V=581, p< 0.05 vs V=385, p=0.95, respectively).

Conclusion & Discussion: In conclusion, the implementation of EMS-administered buprenorphine as part of a broader OUD treatment pathway demonstrates promise in improving patient engagement with healthcare systems. This is especially important because refusals to transport by EMS to the ED post-overdose are increasing (5). These findings underscore the importance of continued efforts to integrate EMS-based interventions with comprehensive care models, addressing both immediate needs and broader healthcare utilization patterns among individuals with OUD.

References: 1. Dowell D. Treatment for Opioid Use Disorder: Population Estimates — United States, 2022. MMWR Morbidity and Mortality Weekly Report. 2024;73(73). doi:https://doi.org/10.15585/mmwr.mm7325a1
2. Kilaru AS, Xiong A, Lowenstein M, et al. Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients. JAMA Network Open. 2020;3(5):e205852. doi:https://doi.org/10.1001/jamanetworkopen.2020.5852
3. Carroll G, Solomon KT, Heil J, Saloner B, Stuart EA, Patel EY, Greifer N, Salzman M, Murphy E, Baston K, Haroz R. Impact of Administering Buprenorphine to Overdose Survivors Using Emergency Medical Services. Ann Emerg Med. 2023 Feb;81(2):165-175. doi: 10.1016/j.annemergmed.2022.07.006. Epub 2022 Oct 1. PMID: 36192278.
4. Zhang X, Wang N, Hou F, Ali Y, Dora-Laskey A, Dahlem CH, McCabe SE. Emergency Department Visits by Patients with Substance Use Disorder in the United States. West J Emerg Med. 2021 Aug 19;22(5):1076-1085. doi: 10.5811/westjem.2021.3.50839. PMID: 34546883; PMCID: PMC8463055.
5. DRUG OVERDOSE SURVEILLANCE DASHBOARD - NEMSIS. NEMSIS. Published August 30, 2024. https://nemsis.org/drug-overdose-surveillance-dashboard/