Feasibility and outcomes from an integrated bridge treatment program for opioid use disorder.

OBJECTIVE: With a significant proportion of individuals with opioid use disorder not currently receiving treatment, it is critical to find novel ways to engage and retain patients in treatment. Our objective is to describe the feasibility and preliminary outcomes of a program that used emergency physicians to initiate a bridge treatment, followed by peer support services, behavioral counseling, and ongoing treatment and follow-up. METHODS: We developed a program called the Houston Emergency Opioid Engagement System (HEROES) that provides rapid access to board-certified emergency physicians for initiation of buprenorphine, plus at least 1 behavioral counseling session and 4 weekly peer support sessions over the course of 30 days. Follow-ups were conducted by phone and in person to obtain patient-reported outcomes. Primary outcomes included percentage of patients who completed the 30-day program and the percentage for successful linkage to more permanent ongoing treatment after the initial program. RESULTS: There were 324 participants who initiated treatment on buprenorphine from April 2018 to July 2019, with an average age of 36 (±9.6 years) and 52% of participants were males. At 30 days, 293/324 (90.43%) completed the program, and 203 of these (63%) were successfully connected to a subsequent community addiction medicine physician. There was a significant improvement (36%) in health-related quality of life. CONCLUSION: Lack of insurance is a predictor for treatment failure. Implementation of a multipronged treatment program is feasible and was associated with positive patient-reported outcomes. This approach holds promise as a strategy for engaging and retaining patients in treatment.

Prevalence and charges of opioid-related visits to U.S. emergency departments.

OBJECTIVE: An overwhelming responsibility for responding to the opioid epidemic falls on hospital emergency departments (ED). We sought to examine the overall prevalence rate and associated charges of opioid-related diagnoses and overdoses. Although charge data do not necessarily represent cost, they are proxy indicators of resource utilization and burden. METHODS: We conducted a retrospective study of the National Emergency Department Sample (NEDS) dataset, the largest all-payer ED database in the United States. We queried using specific relevant ICD-10 codes to estimate the number of adult ED visits for both opioid poisonings and other opioid-related diagnoses during 2016 and 2017, which was the most recent publicly available data. Prevalence rates and financial charges were calculated by year and odds ratios were used to examine differences. RESULTS: Of approximately 234 million adult visits to EDs across 2016 and 2017, 2.88 million (1.23%) were related to opioids, with overdoses comprising nearly 27.5% and visits for other opioid-related diagnoses totaling 72.5%. As the primary diagnosis, opioids were responsible for 37% of all ED visits across both years. Total opioid-related visits for the two years accounted for $9.57 billion in ED charges, or $4.78 billion annually, with Medicaid and Medicare responsible for 66% of all charges. CONCLUSION AND RELEVANCE: Approximately one of every 80 visits to the ED were opioid-related, leading to financial charges approaching $5 billion per year. Since both prevalence and the economic burden of opioid-related visits are high, targeted interventions to address this epidemic's impact on healthcare systems should be a national priority.

Alternatives to Arrest for Illicit Opioid Use: A Joint Criminal Justice and Healthcare Treatment Collaboration.

Opioid overdoses continue to be a leading cause of death in the US. This public health crisis warrants innovative responses to help prevent fatal overdose. There is continued advocacy for collaborations between public health partners to create joint responses. The high correlation between persons with opioid use disorder who have a history of involvement in the criminal justice system is widely recognized, and allows for treatment intervention opportunities. Law enforcement-led treatment initiatives are still relatively new, with a few sparse early programs emerging almost a decade ago and only gaining popularity in the past few years. A lack of published methodologies creates a gap in the knowledge of applied programs that are effective and can be duplicated. This article seeks to outline an interagency relationship between police and healthcare that illustrates arrest is not the only option that law enforcement may utilize when encountering persons who use illicit substances. Program methods of a joint initiative between law enforcement and healthcare in a large, metropolitan area will be reviewed, supplemented with law enforcement overdose data and statistics on law enforcement treatment referrals.

Developing interagency collaboration to address the opioid epidemic: A scoping review of joint criminal justice and healthcare initiatives.

BACKGROUND: With the current opioid epidemic impacting well over half of all counties across the United States, initiatives that encourage interagency collaboration between first responder organizations appear necessary to comprehensively address this crisis. Police, fire, and emergency medical services (EMS) are in a unique position to identify substance users and provide necessary resources to initiate treatment, yet there is not sufficient evidence of joint collaborative programs between law enforcement/first responders and healthcare providers. METHODS: In this scoping review we examine the current state of joint criminal justice and healthcare interventions, specifically, opioid and substance use pre-arrest initiatives via emergency first responders and police officers. We relied on data from the last 10 years across three major databases to assess the extent of criminal justice (CJ) and healthcare collaborations as a response to individuals with opioid use disorder (OUD). We specifically focused on interventional programs between criminal justice first responders (pre-arrest) and healthcare providers where specific outcomes were documented. RESULTS: We identified only a small number (6) of studies involving interventions that met this criteria, suggesting very limited study of joint interagency collaboration between law enforcement first responders and healthcare providers. Most had small samples, none were in the southern states, and all but one were initiated within the last 5 years. CONCLUSIONS: Although studies describing joint efforts of early intercept criminal justice responses and healthcare interventions were few, existing studies suggest that such programs were effective at improving treatment referral and retention outcomes. Greater resources are needed to encourage criminal justice and healthcare collaboration and policies, making it easier to share data, refer patients, and coordinate care for individuals with OUD.