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. 2025 Jul 1;8(7):e2520661.
doi: 10.1001/jamanetworkopen.2025.20661.

Racial and Ethnic Factors and Opioid Use Disorder Treatment After an Emergency Department Visit

Edouard Coupet Jr  1   2 , Marek C Chawarski  1   2   3 , Kavari Hercules  4 , Joseph L Williams  5 , Alexandra Murphy Ward  6 , Patricia H Owens  1 , David A Fiellin  1   2   4 , Kathryn F Hawk  1   2   4 , Shara H Martel  1 , Gail D'Onofrio  1   2   4
Affiliations

Racial and Ethnic Factors and Opioid Use Disorder Treatment After an Emergency Department Visit

Edouard Coupet Jr et al. JAMA Netw Open. .

Abstract

Importance: There are racial and ethnic disparities in opioid use disorder (OUD) treatment engagement during and after emergency department (ED) encounters.

Objective: To identify patterns of barriers and facilitators to treatment engagement after an ED visit among Black, Hispanic, and White individuals with OUD.

Design, setting, and participants: This qualitative study was conducted from June 2023 to May 2024 using in-depth semistructured individual telephone interviews. Participants with OUD were previously enrolled in a multisite study comparing 2 formulations of buprenorphine in ED patients with untreated OUD on treatment engagement.

Exposures: A diagnosis of moderate-to-severe OUD and a visit to an ED.

Main outcomes and measures: The primary outcome was identification of key themes at both the behavioral and health system levels associated with treatment engagement, identified through thematic analysis of interview data.

Results: A total of 57 individuals (20 female [35.1%]; mean [SD] age, 41.7 [12.8] years; 20 Black [35.1%]; 17 Hispanic [29.8%]; 20 White [35.1%]) participated in the study. Although racial and ethnic group-specific factors existed, common barriers to treatment engagement included stigma, structural factors (eg, transportation and insurance), uncertainty navigating the health system, and mental health issues. Black participants specifically described how previous trauma and daily stress contributed to a lack of treatment engagement. Black and Hispanic participants expressed experiences of racism and mistrust within the health system. Hispanic and White participants expressed concerns about the adverse effects and taste of sublingual buprenorphine. Common facilitators included positive attitudes toward treatment and patient experiences with ED staff and stable health care access. Hispanic participants described family support as a crucial factor toward treatment engagement. Black participants expressed the importance of connecting with individuals who were abstinent.

Conclusions and relevance: In this qualitative study of 57 individuals with OUD previously treated in the ED, common themes emerged across racial and ethnic groups. However, Black, Hispanic, and White individuals with OUD encountered distinct barriers and facilitators to treatment engagement after an ED visit, such as the importance of family support among Hispanic individuals as a facilitator and experiences of racism within the health system among both Black and Hispanic individuals as a barrier. Future ED-based interventions should address disparities by reducing barriers and enhancing facilitators to improve equitable treatment access.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Fiellin reported receiving honoraria from the American Society of Addiction Medicine for serving as Editor-in-Chief of the Journal of Addiction Medicine; Dr Fiellin’s spouse is founder of Playbl, which disseminates serious video games for substance use prevention. Dr Hawk reported receiving grants from Foundation for Opioid Response, Elevance Foundation, and the National Institute of Alcohol Abuse and Alcoholism outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Patient Enrollment Flowchart
The total number of eligible calls refers to the total number of individuals evaluated and/or calls placed to determine study participation. Nonresponders were participants who were not included in the study, with reasons such as declining to participate, unavailable, or other criteria. Participants who consented and completed all study procedures were enrolled. aParticipant completed a portion of the interview and finished the rest at a later time.
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