Survey of Kentucky Hospitals Sheds Light on Emergency Room Care for Substance Use Disorders

By: Samantha J. Harris and Olivia K. Sugarman

Emergency departments are a critical access point to care for people who use drugs. In many cases, EDs provide life-saving care in the event of an overdose and are a healthcare hub for other substance use disorder related health needs, such as endocarditis or soft tissue wounds. However, the risks of future overdose and worsening health increase substantially if people who use drugs do not receive follow-up substance use disorder care.

To help patients close that gap, emergency departments are beginning to offer a host of new initiatives and programs, from universal substance use disorder screening, providing the overdose-reversal drug naloxone at discharge, staffing peer support specialists to help patients navigate health care systems, and establishing “bridge clinics.”

Bridge clinics are a newer model of emergency-department initiated care that help people start medications for opioid use disorder (e.g. buprenorphine) in the emergency department, then connect them to longer-term, sustainable substance use disorder care via warm handoff referrals. Peer support specialists provide critical social support to patients with substance use disorder when hospitalized, and can assist with connecting patients to care and other services following discharge.

Despite the evidence supporting bridge programs and other emergency department-based substance use disorder initiatives, their implementation is not widespread.

In partnership with the Kentucky Statewide Opioid Stewardship program and Vital Strategies, researchers from the Bloomberg Overdose Prevention Initiative at the Johns Hopkins University Bloomberg School of Public Health surveyed all of Kentucky’s emergency departments. The survey aimed to understand their readiness to implement these services for the first time or to expand existing bridge programs. We received responses from 85 hospitals between January to May of 2023, at which time the state had 9 hospitals with existing bridge programs.

We asked hospital emergency department directors what, if any, of these services they already offered, and what the most challenging aspects of implementing bridge services were/would be.

The responses were illuminating. Many respondents believed buprenorphine induction was the greatest challenge (42%). The most commonly cited reasons for not offering buprenorphine were low willingness to prescribe and lack of knowledge about buprenorphine prescribing. Additionally, making referrals to community treatment providers (40%) and offering social work services (29%) were named as key challenges, often due to limited availability. Several noted that improved screening protocols were needed, and that having peer support specialists on staff was an invaluable resource. Many were interested in receiving support for implementing bridge services and strengthening peer support specialist staffing, as shortages of staffing and financial resources were seen as a key barrier.

In Kentucky, the Kentucky Hospital Association planned to hire peer support specialists in areas in greatest need. As states consider how to use opioid litigation funds, investing into evidence-based interventions (Principle 2), like scaling up bridge programs and improving access to methadone and buprenorphine, should be a key priority. Following Kentucky’s lead, other states may consider conducting needs assessments of their emergency departments to inform resource allocation and support needs for hospitals to implement these programs as a first step.

You can read the study here.

About the authors:

Samantha J. Harris is an Assistant Scientist at the Bloomberg School of Public Health who researches health services and policies to improve the lives of those impacted by substance use disorders and mental health conditions.

Olivia K. Sugarman is a health services and policy researcher who specializes in overdose prevention, HIV and HCV, and the effects of incarceration on health. She is an Assistant Scientist at the Bloomberg School of Public Health.