261 Identifying Barriers to Emergency Department-Initiated Buprenorphine: A Spatial Analysis of Treatment Program Access in Michigan

Abstract

Emergency department (ED)-initiated medication-assisted treatment (MAT) with buprenorphine/naloxone has been shown to improve treatment retention and reduce illicit opioid use, however, its potential may be limited by a lack of accessible community-based programs. This study compared one state’s geographic distribution of EDs to outpatient treatment facilities that prescribe buprenorphine, and identified emergency department and county-level factors associated with buprenorphine program access. Treatment facility data was obtained from the SAMHSA 2018 National Directory of Drug and Alcohol Abuse Treatment Facilities, and Michigan emergency department data was obtained from the state chapter of the American College of Emergency Physician’s 2018 ED directory. Opioid prescribing, opioid overdose, and opioid-related hospitalization statistics were obtained from the Michigan Department of Health and Human Services (DHHS) 2017 data set. Sociodemographic data were acquired from the U.S. Census Bureau. Geospatial analysis compared EDs to buprenorphine treatment facilities using 5 and 10 mile radii. Among 131 non-exclusively pediatric emergency departments in Michigan, 57 (43.5%) had a buprenorphine-prescribing treatment facility within 5 miles, and 66 (50.4%) had a facility within 10 miles; of the latter, 61 (92.4%) took Medicaid, and 59 of 61 (96.7%) offered outpatient services. EDs within 10 miles of a Medicaid-accepting, outpatient buprenorphine treatment facility had higher average numbers of beds (41 vs. 15; p<0.0001) and annual patient volumes (58,616 vs. 17,484; p<0.0001) compared to those without. Of Michigan’s 83 counties, 72 (86.7%) were reported to have at least one ED in 2018; 27 (37.5%) of these were in counties with buprenorphine treatment programs. Compared to ED-containing counties with buprenorphine treatment facilities, those counties without such services were more likely to have smaller average populations (82,910 vs. 221,094; p=0.04) and higher proportions of residents with low educational attainment (10.9% vs. 9.0%; p<0.01), but similar proportions of residents with low income (16.8% vs. 16.2%; p=0.56) and unemployment (4.7% vs. 4.9%; p=0.61). ED-containing counties without and with buprenorphine programs had similar rates of opioid prescribing (1.08 vs. 1.01; p=0.21), opioid-related hospitalizations (19.0 vs. 20.8 per 100,000; p=0.53), and opioid overdose deaths (13.5 vs. 17.5 per 100,000; p=0.08). Only half of Michigan’s emergency departments are within 10 miles of an outpatient buprenorphine-prescribing treatment facility, despite similar rates of opioid-related morbidity statewide. Given both the limited access of EDs to buprenorphine treatment facilities (especially in less populous areas), and the ongoing opioid overdose crisis, expanding ED-initiated MAT in states similar to Michigan may require alternative models of care.