74 Using an Observation Unit to Decrease Disparities in Opiate Medically Assisted Treatment Program Follow Up

Abstract

The opioid use disorder epidemic has increased dramatically in the last two decades. Medication-assisted therapy (MAT) for opioid use is a well-established tool for addressing the opioid epidemic. Despite the proven success there are small studies suggesting that black patients and women are less likely to receive medically assisted treatment during opiate rehabilitation. Even with the rise of emergency department-initiated medically assisted treatment programs (MATP) for opiate dependency, little research exists investigating sex or race differences in enrollment to them. Emergency Department Observation Units (EDOUs) are ideally protocol driven patient care areas where decisions can be made about whether to admit a patient or discharge to home. For patients with opioid use disorder, there may be a confounding ingestion which would complicate withdrawal and thus necessitate an inpatient admission. This decision, made in concert with a toxicologist, can be combined with a warm handoff (invitation to clinic and initiation). Aim: to determine the rate of follow up in a MATP with an EDOU providing a ‘warm-handoff’ and also to determine if there is variance in race and sex from the visits to this EDOU and MATP follow up. Out hypothesis was that patients placed in the EDOU using a ‘warm-handoff’ mechanism in concert with toxicology would have an attrition rate to the MAOT clinic less than 50% and have insignificant race and sex variance in MATP follow up. We retrospectively collected data on patients placed in a protocol driven EDOU from the emergency department, over 22 months (January 2018 and October 2019). While in the EDOU, patients were evaluated for co-ingestants, evaluated by a toxicologist who assessed their level of withdrawal and used this information to initiate suboxone therapy and arrange follow up in the toxicology administered medication-assisted therapy clinic. The association between sex, race, and clinic follow-up was evaluated using a logistic regression which included the main effects of sex and race, and the two-way interaction. There were a total of 101 uses of the EDOU suboxone protocol during the study period of which 88 were unique cases and included full outcome data. 34 patients (38.6%) identified as White and 59 (67.0%) identified as Male. The median age was 39 (IQR: 30 - 54) and the median COWS score was 10.5 (IQR: 6 - 14). Of these 39 (44.3%) followed up in our MATP. Neither sex (OR = 1.0, 95% CI: 0.99 - 1.01), race (OR = 0.22, 95% CI: 0.04 - 1.33), nor the interactions between these factors (OR = 3.46, 95% CI: 0.43 - 27.6) were significant. Although the numbers are small, this single center study suggests that using an EDOU and standardizing the pathway to MAT may help eliminate disparities that have been described in larger populations in systems without a ‘warm-handoff’ mechanism. Further epidemiologic studies to understand this population and prospective studies are needed on the issue to best describe the role of the EDOU in this epidemic.