Written by Denrick Cooper
Spoon Feed
Although ED-initiated treatment is effective, naloxone and medication for opioid use disorder (MOUD) continue to be markedly underutilized in routine practice.
More MOUDs please!
Opioid use disorder (OUD) accounts for roughly 2.9 million ED visits annually, positioning the ED as a critical access point for initiating life-saving treatment. Yet large disparities persist in who receives MOUD, reflecting broader inequities across socioeconomic, racial, linguistic, and geographic lines. Because the ED treats patients regardless of background or insurance status, ED-initiated therapy remains one of the most equitable and effective ways to close these gaps.
This study assessed how often EDs across the country provide naloxone and MOUD during visits related to OUD or overdose. Using data from 300 participating EDs and 6,749 qualifying visits, naloxone was prescribed or dispensed in only 27.8% of encounters. MOUD initiation was even less common, occurring in just 7.3% of eligible patients. Buprenorphine was administered in 5.9% of visits and methadone in 2.4%.
The study’s generalizability is limited by its sample composition—primarily southern, rural, community, and critical-access hospitals—and reliance on ICD-10 coding, which introduces potential selection and classification bias.
How does this change my practice?
I already prescribe naloxone and initiate MOUD in my own practice, but this study reinforces that I still don’t do it as consistently as I could—and I’m not alone. Despite strong evidence, ED-initiated treatment remains underused across the country, and this paper demonstrates we have room to improve. Integrating EMR prompts, standardized pathways, and stronger institutional support—whether through workflow design, discharge planning, or automated reminders—can help ensure we don’t miss these critical opportunities. Ultimately, this study challenges me, and our specialty as a whole, to expand and normalize ED-initiated OUD treatment so more patients receive the care they need.
Source
Treatment of Opioid Use Disorder Across a National Emergency Department Practice Improvement Network. Ann Emerg Med. 2025 Oct 9:S0196-0644(25)01216-8. doi: 10.1016/j.annemergmed.2025.09.010. Epub ahead of print. PMID: 41071133.
