Health Policy and Health Services Research
Background: Over the past decade, opioid abuse has emerged as a major public health concern, and was declared a nationwide emergency in 2016. Medication-assisted treatment (MAT) initiated in Emergency Department (ED) settings has been shown to be effective for the treatment of opioid use disorder; however, trends in usage of MAT have not been described.
Methods: We performed a retrospective analysis to describe trends in MAT administration or prescription among opioid-related ED visits resulting in discharge using the 2011-2016 National Hospital Ambulatory Medical Care Survey (NHAMCS). We defined opioid-related visits as those with an ICD9 or ICD-10 primary diagnosis related to opioid use disorder using diagnostic codes previously defined in the literature. We calculated unweighted and population-weighted frequencies for all visits and then excluded those resulting in hospital admission. We identified MAT utilization using the variable “medications administered or prescribed” and tabulated frequencies using the Multum nomenclature. For each year, we calculated rates for opioid related ED visits, and administration of buprenorphine, methadone and naltrexone. Data analysis was conducted using SAS.
Results: The average rate of opioid related ED visits (excluding visits resulting in hospital admission) from 2011-2016 was 648,287 visits per year, or 265.1 visits per 100,000 U.S. adults. Opioid-related visit rates increased by 41.8% from 2011 to 2016, from 203.8 per 100,000 to 289 per 100,000 in 2016. In each year, there were fewer than 30 recorded administrations of methadone, buprenorphine, and naltrexone. Because population weights for events with unweighted frequencies below 30 are unreliable, we were unable to calculate weighted frequencies.
Conclusion: Opioid-related ED visits have increased by over 40% from 2011 to 2016. Despite the substantial number of opioid-related acute care encounters and increase in opioid-related ED visits, MAT utilization in the ED has remained nearly undetectable, even as recently as 2016. Further research is needed to improve dissemination and implementation, including potentially reducing barriers to clinician training and MAT prescribing, in order to overcome this public health gap.