Headline

A substance use navigator program embedded in emergency departments of an urban health system increased rates of treatment engagement post-discharge.

Context

Rates of substance use disorder-related mortality are rising and substance use disorders are increasing since COVID-19. There is growing support for leveraging emergency departments (EDs) as settings to deliver evidence-based substance use disorder care, including starting medications for opioid use disorder. This implementation study evaluates the effectiveness of an ED-based, whole person care-informed intervention delivered by substance use navigators (SUNs), who are community health workers specializing in substance use and co-occurring mental health conditions. The study compares findings to standard care for ED patients with substance use disorders in an urban public health system.

Findings

The authors examined data from the health system electronic health record to evaluate program effectiveness across a nearly one-and-a-half-year period for the more than 1,300 patients in the cohort. Overall, a significant percentage of patients with the SUN intervention were engaged in treatment within 30 days after ED discharge compared to those without the intervention (50% to 16%). Patients with SUN interventions also had significantly higher rates for administration of and prescriptions for medications for addiction treatment in the ED compared to those without the intervention (40% vs. 17%; 48% vs. 21%).  A key feature contributing to the success of the SUN intervention were the nudges to clinicians to use ED treatment protocols and facilitation of patients at discharge to outpatient clinics.

Takeaways

Notably, the EDs in this study had locally established ED addiction treatment protocols and access to a low-threshold addiction medicine clinic (bridge clinic). These findings suggest that the dedicated and proactive care navigation provided to patients by the SUNs can yield more optimal results than the investments of the ED addiction treatment protocols or bridge clinic alone.