The COVID-19 pandemic has exacerbated longstanding inequities in opioid use disorder (OUD) that reflect multiple facets of structural racism. In Massachusetts, opioid overdose deaths in 2020 rose by nearly 70% in Black men compared to just 5% overall. Emergency department (ED) visits in people with OUD may represent key touchpoints for overdose prevention. Although racial inequities in buprenorphine and methadone maintenance initiation, dosing, and retention have been well documented, less is known about the administration of medications for opioid use disorder (MOUD, buprenorphine and methadone), in the ED. ED leadership initiated an internal review to explore racial equity in multiple clinical quality metrics, including frequency of MOUD administration in patients with OUD. Retrospective data were analyzed for quality improvement (QI) purposes. Patients presenting to the ED with OUD July 29, 2020-March 12, 2021 were identified via ICD-10 codes. Patient demographics and MOUD administration were explored using descriptive statistics; c2 tests compared the frequency of MOUD administration by race. An intensive QI intervention to improve MOUD utilization will be delivered to all ED prescribers in June 2021. The intervention includes content on racial inequities in OUD treatment and factors that drive them, including provider bias, reasons for mistrust of the medical system among patients of color, and structural barriers to OUD treatment and retention. Through educational sessions for providers, transparency of data of current MOUD trends in the ED, and structured on-shift reminders by ED pharmacists, we plan to improve provider-patient communication and MOUD utilization in the ED. The QI initiative will be followed by a three-month monitoring period (July-September 2021) to evaluate for changes in MOUD administration. A total of 998 unique patients with OUD were seen for 1452 ED visits. Documented race was 56.7% White, 21.5% Black, 13.5% Hispanic, 1.7% Other, and 6.6% unknown. MOUD were administered during 945/1452 visits (65.1%). The likelihood of administration varied significantly by race: 80.3% of White patients received MOUD compared to 35.9% of Black patients, and 59.9% of Hispanic patients (p<0.001, Table 1). Significant differences in treatment were also observed when comparing white and Black patients (p<0.001) and white and Hispanic patients (p<0.001) directly. Renewed attention to ensuring racial equity in clinical practice prompted an exploration of ED data at our institution, including equitable administration of buprenorphine and methadone in patients with OUD. This QI analysis identified a racial inequity, prompting the development of a QI initiative to improve overall utilization of MOUD, with a specific focus on mitigating observed racial inequities. Data analysis from the post-QI intervention period will be completed prior to presentation at ACEP.