Opioids: Which Intervention Works Best in EDs?

Distressed Patient

Emergency departments are on the front lines of the opioid epidemic. EDs have everything to gain by doing more than just stabilizing patients or denying prescriptions. A more proactive approach can not only help the patient but can improve long wait times, overcrowding and low patient satisfaction.    

EDs can begin the intervention process for patients presenting with symptoms of opioid dependence. A study published last year in the Journal of the American Medical Association looked at three interventions and their efficacy.

3 Intervention Approaches and Their Effectiveness

1. Referral
This study involved over 300 opioid-dependent patients at an urban teaching hospital, each randomly assigned to three types of intervention, and studied over the course of 30 days. After screening, this first group was provided a handout with names, locations and telephone numbers of local treatment services, which varied by type and intensity. Patients were also allowed to call a clinician or treatment facility of their choice from the ED. By merely providing patients with information and tools for treatment, researchers saw that 37 percent of participants were engaged in addiction treatment at the 30-day mark.

2. Brief Intervention
In this group, patients received a brief negotiation interview (10 to 15 minutes) from a research associate containing four components:

  •      Raise the subject.
  •      Provide feedback.
  •      Enhance motivation.
  •      Negotiate and advise. 

Treatment options were then discussed, with similar information provided that those patients in the referral group received. With this more focused intervention, 45 percent of patients were engaged in addiction treatment at the 30-day mark.

3. Buprenorphine Treatment
In this final group, patients received the same brief negotiation interview as those in the brief intervention group received. If symptoms of moderate to severe opioid withdrawal were apparent, then ED-initiated treatment with buprenorphine was started. Patients were given enough medication to take home until an appointment in the hospital’s primary care center, when a 10-week course of treatment of buprenorphine was introduced. At the conclusion of the 10 weeks, patients continued treatment in a community program, clinician-lead program or a two-week detox program.

At day 30, 78-percent of patients were still engaged in addiction treatment and illicit opioid use dropped from 5.4 days per week, to just under one. (The referral group saw a reduction of illicit opioid use to 2.3 days per week and the brief intervention to 2.4 days per week.)

All three interventions increased engagement in treatment for opioid-dependent patients, but it’s clear a more intensive, hands-on intervention with medication treatment offered to this study’s third group proved more effective. The authors say that there still needs to be more studies.

Does your ED have an intervention strategy it implements for opioid-dependant patients? If so, I’d love to hear about it. Please comment below and share what has or hasn’t worked for you or feel free to drop me a line. If you’d like an assist with fine-tuning your ED's operation, no matter which challenges you’re facing, check out my company’s website to see if we may be a fit for you.


The Journal of the American Medical Association: “Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence.”