An emergency-department-initiated outreach program for patients with opioid use disorder is associated with an increase in agonist therapy and engagement in addictions care: a one-year cohort study

Rukaiyah Lakkadghatwala; Daniel Lane; Frank Scheuermeyer; Jesse Hilburt; Jane Buxton; Cheyenne Johnson; Seonaid Nolan; Christy Sutherland; Jessica Moe; Raoul Daoust; Kathryn Dong; Jim Christenson; Isabelle Miles; Aaron Orkin; Madelyn Whyte; Andrew Kestler

doi:10.1186/s13011-023-00578-3

An emergency-department-initiated outreach program for patients with opioid use disorder is associated with an increase in agonist therapy and engagement in addictions care: a one-year cohort study

Subst Abuse Treat Prev Policy. 2024 Feb 21;19(1):14. doi: 10.1186/s13011-023-00578-3.

Authors

Rukaiyah Lakkadghatwala¹, Daniel Lane², Frank Scheuermeyer³, Jesse Hilburt⁴, Jane Buxton⁵, Cheyenne Johnson⁶, Seonaid Nolan⁷, Christy Sutherland⁸, Jessica Moe⁹, Raoul Daoust¹⁰, Kathryn Dong¹¹, Jim Christenson³, Isabelle Miles³, Aaron Orkin¹², Madelyn Whyte¹³, Andrew Kestler¹⁴

Affiliations

¹ Department of Emergency Medicine, Surrey Memorial Hospital & Richmond Hospital, University of British Columbia, Vancouver, Canada. rlakkadghatwala@qmed.ca.
² Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
³ Department of Emergency Medicine & St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
⁴ Vancouver Coastal Health Overdose Outreach Team & St. Paul's Hospital, Vancouver, Canada.
⁵ School of Population and Public Health & BC Centre for Disease Control, University of British Columbia, Vancouver, Canada.
⁶ BC Centre on Substance Use & University of British Columbia School of Nursing, Vancouver, Canada.
⁷ Department of Medicine & BC Centre on Substance Use, University of British Columbia, Vancouver, Canada.
⁸ Department of Family Practice, PHS Community Services Society & BC Centre on Substance Use, University of British Columbia, Vancouver, Canada.
⁹ Department of Emergency Medicine, BC Centre for Disease Control & Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
¹⁰ Département Médecine de Famille Et Médecine d'Urgence, Université de Montréal, Hôpital Sacré-Coeur de Montréal & CIUSSS Nord-de-L'ile, Montreal, Canada.
¹¹ Department of Emergency Medicine, University of Alberta, Edmonton, Canada.
¹² Department of Family & Community Medicine, Inner City Health Associates Toronto & St. Joseph's Health Centre, University of Toronto, Toronto, Canada.
¹³ Foundry BC, Vancouver, Canada.
¹⁴ Department of Emergency Medicine, Vancouver Coastal Health, BC Centre on Substance Use & St. Paul's Hospital, University of British Columbia, Vancouver, Canada.

Abstract

Background: People with opioid use disorder (OUD) are high-risk for short-term mortality and morbidity. Emergency department (ED) interventions can reduce those risks, but benefits wane without ongoing community follow-up.

Objective: To evaluate an ED-based intensive community outreach program.

Methods: At two urban EDs between October 2019 and March 2020, we enrolled patients with OUD not currently on opioid agonist therapy (OAT) in a prospective cohort study evaluating a one-year intensive community outreach program, which provided ongoing addictions care, housing resources, and community support. We surveyed patients at intake and at scheduled outreach encounters at one, two, six, and twelve months. Follow-up surveys assessed OAT uptake, addictions care engagement, housing status, quality of life scores, illicit opioid use, and outreach helpfulness. We used descriptive statistics for each period and conducted sensitivity and subgroup analyses to account for missing data.

Results: Of 84 baseline participants, 29% were female and 32% were housed, with a median age of 33. Sixty participants (71%) completed at least one follow-up survey. Survey completion rates were 37%, 38%, 39%, and 40% respectively at one, two, six, and twelve months. Participants had a median of three outreach encounters. Among respondents, OAT was 0% at enrolment and ranged from 38% to 56% at follow-up; addictions care engagement was 22% at enrolment and ranged from 65% to 81% during follow-up; and housing was 40% at enrolment and ranged from 48% to 59% during follow-up. Improvements from baseline to follow-up occurred for all time periods. OAT and engagement in care benefits were maintained in sensitivity and subgroup analyses. Respondents rated the outreach program as helpful at all time periods, CONCLUSION: An ED-initiated intensive outreach program for patients with OUD not yet on OAT was associated with a persistent increase in OAT use and engagement in care, as well as housing.

Keywords: Addiction; Emergency medicine; Opioid; Opioid agonist therapy; Opioid use disorder; Prospective cohort study; Substance use disorder.

MeSH terms

Analgesics, Opioid* / therapeutic use
Cohort Studies
Emergency Service, Hospital
Female
Humans
Male
Opiate Substitution Treatment
Opioid-Related Disorders* / drug therapy
Prospective Studies
Quality of Life

Substances

Analgesics, Opioid