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?:abstract
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Study Objectives: There is growing evidence that medication assisted therapy (MAT) which includes buprenorphine can lead to improved outcomes for patients with opiate use disorder (OUD), increased follow up with addiction treatment programs, as well as reduced illicit drug use and medical system costs for drug related emergency department (ED) visits Emergency providers may serve to provide an induction to MAT and referrals to outpatient MAT providers However, there continue to be barriers to utilization of buprenorphine from the ED including fears of precipitating withdrawal, fears of diversion or overdose, and beliefs that additional licenses are needed to offer treatment The novel coronavirus epidemic threatens to pose even greater barriers to treatment access EDs continue to serve patients throughout this crisis and may provide a critical role in continuing to link patients to MAT and provide care to patients with OUD Methods: Our institution had planned to study the impact of an X-waiver training program for residents in our large, urban residency program Closures during the coronavirus decreased patient volumes for many health care settings, especially outpatient clinics where much of MAT is delivered We hypothesized that the “safer at home” order would have minimal impact on the percentage of patients presenting with OUD related complaints, as this would be coupled with less access to community resources that had previously provided support We considered OUD-related ED visits as those which included any of the following: visits with a discharge diagnosis related to OUD, patients administered buprenorphine or naloxone while in the ED, and visits where a prescription for buprenorphine or naloxone was given on discharge We analyzed these visit rates compared with all ED visits per month Results: The number of ED visits in January 2020 and February 2020 were 13,933 and 12,639 with rates of OUD-related visits 24 and 32 per 10,000, respectively Social distancing guidelines were announced in Los Angeles on March 11, and stay at home orders began March 19, 2020 In April and May, there were 6,649 and 8,385 ED visits, however, rates of OUD-related visits were 59 and 35 per 10,000 Conclusion: Restrictive requirements on MAT dispensation already limits access to office-based treatment;during the coronavirus, the closure of clinics and other ancillary services to support persons with OUD threaten those most at risk of relapse The COVID-19 pandemic and the changes in response to it have exacerbated disparities for marginalized populations In order to combat these disparities, we need to recognize and bolster the systems of care serving these patient groups Our ED continued to see steady rates of OUD-related visits, reinforcing the importance of continuing efforts to provide MAT from our social safety net ED MAT programming represents an important portal to care, especially as a stop gap when other access points are destabilized [Formula presented]
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