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. 2025 Jul 1;8(7):e2518569.
doi: 10.1001/jamanetworkopen.2025.18569.

Disparities in Treatment and Referral After an Opioid Overdose Among Emergency Department Patients

Siri Shastry  1 , Joseph Carpenter  2   3 , Alex Krotulski  4 , Jeffrey Brent  5 , Paul Wax  6   7 , Kim Aldy  6   7 , Sharan Campleman  6 , Rachel Culbreth  6 , Alyssa Falise  6 , Adrienne Hughes  8 , Robert G Hendrickson  8 , Alexandra Amaducci  9 , Bryan Judge  10 , Christopher Meaden  11 , Diane P Calello  11 , Jennie Buchanan  12 , Joshua Shulman  13 , Michael Levine  14 , Evan Schwarz  14 , Alex F Manini  15   16
Affiliations

Disparities in Treatment and Referral After an Opioid Overdose Among Emergency Department Patients

Siri Shastry et al. JAMA Netw Open. .

Abstract

Importance: There is a disproportionately high rate of overdose deaths immediately following an emergency department (ED) visit for opioid overdose. Thus, an improved understanding of disparities in ED treatment and referral is vital. Racial and ethnic disparities in access to naloxone and buprenorphine have been described in the outpatient setting but prevalence in the ED setting remains understudied.

Objective: To examine racial and ethnic disparities in treatment referral rates in ED patients with opioid overdose.

Design, setting, and participants: This is a secondary analysis of a prospective consecutive cohort from the Toxicology Investigators Consortium (TOXIC) Fentalog Study from September 21, 2020, to November 11, 2023. Ten hospital sites were a part of the TOXIC network and participants included ED patients in aged 18 years or older with opioid overdose. Data were analyzed from December 2022 to March 2025.

Exposures: Patient race, ethnicity, sex, and other demographic and clinical factors of interest.

Main outcomes and measures: Study outcomes included the proportion of patients receiving a referral to outpatient addiction care and the proportion receiving a naloxone kit or prescription or buprenorphine prescription at discharge. Descriptive statistics were tabulated, and χ2 and multivariable logistic regression analyses were used to evaluate for differences by race, ethnicity, sex, and other demographic and clinical variables.

Results: In this study, 1683 patients met all inclusion criteria (mean [SD] age, 42.5 [14.5] years; 1221 males [72.6%]; 461 females [27.4%]; 447 Black patients [26.6%]; 63 Hispanic patients [4.3%]; 867 White patients [51.5%]). Of the 1683 included patients, 299 (17.8%) received a referral for outpatient treatment, 713 (42.4%) received a naloxone kit or prescription, and 141 (8.4%) received a buprenorphine prescription. Compared with White patients, Black patients had a decreased adjusted odds ratio (aOR) of outpatient treatment referral (aOR, 0.67; 95% CI, 0.47-0.97). Hospital admission was also associated with increased adjusted odds of outpatient treatment referral (aOR, 3.13; 95% CI, 2.34-4.20). Geographic variation was associated with all primary and secondary outcomes.

Conclusions and relevance: In this study, Black patients were less likely to receive outpatient referrals for OUD. These findings underscore the need for targeted interventions to address racial disparities in ED care for OUD, particularly in enhancing referral processes.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Carpenter reported receiving grants from the National Institute on Drug Abuse, Centers for Disease Control and Prevention, and Health Resources and Services Administration outside the submitted work. Dr Wax reported receiving grants from Icahn School of Medicine during the conduct of the study. Dr Judge reported receiving nonfinancial support from Michigan State University during the conduct of the study. Dr Buchanan reported receiving grants from Denver Health and Hospital Authority during the conduct of the study. No other disclosures were reported.

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References

    1. Dowell D, Brown S, Gyawali S, et al. Treatment for opioid use disorder: population estimates—United States, 2022. MMWR Morb Mortal Wkly Rep. 2024;73(25):567-574. doi: 10.15585/mmwr.mm7325a1 - DOI - PMC - PubMed
    1. D’Onofrio G, McCormack RP, Hawk K. Emergency departments—a 24/7/365 option for combating the opioid crisis. N Engl J Med. 2018;379(26):2487-2490. doi: 10.1056/NEJMp1811988 - DOI - PubMed
    1. Shastry S, Counts C, Shegog E, Loo G, Cowan E. Emergency department utilization patterns in patients with opioid-related emergency department visits. Subst Use Misuse. 2022;57(6):995-998. doi: 10.1080/10826084.2022.2046098 - DOI - PMC - PubMed
    1. D’Onofrio G, O’Connor PG, Pantalon MV, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636-1644. doi: 10.1001/jama.2015.3474 - DOI - PMC - PubMed
    1. Herring AA, Rosen AD, Samuels EA, et al. Emergency department access to buprenorphine for opioid use disorder. JAMA Netw Open. 2024;7(1):e2353771. doi: 10.1001/jamanetworkopen.2023.53771 - DOI - PMC - PubMed

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