Close Emergency Department Follow-up After Opioid-related Visit Modestly Associated with Reduced Incident Overdose

Opioid-related emergency department (ED) visits represent a potential opportunity to engage patients in needed addiction care, especially if close follow-up for ongoing care can be arranged. Follow-up for opioid use disorder (OUD) care within 7 days of an ED visit has been proposed as an indicator of quality for addiction care. This study used data from 11 US state Medicaid programs to describe the association between ED follow-up within 7 days and subsequent hospital treatment of opioid overdose in a population with relatively high rates of OUD-related ED visits.

• Of the 114,945 patients in 11 states who experienced an ED visit that included an OUD-related diagnosis (including overdose) from 2016–2018, 16% had a follow-up visit within 7 days, with substantial variability across states (7% to 22%).
• Patients with a timely follow-up visit were more likely to be female and non-Hispanic White, less likely to have had an overdose or other substance use disorder diagnosis at the time of the ED visit, and much more likely to have been receiving medication for OUD (MOUD) prior to the ED visit.
• In multivariable analyses, having a follow-up visit within 7 days was associated with a lower likelihood of overdose within 6 months of the ED visit (hazard ratio, 0.91). However, results varied across states and only 2 states had statistically significant results.

Comments: Follow-up rates within 7 days after an OUD-related ED visit were very low in this 11-state Medicaid population, indicating substantial gaps in care. The high variability in follow-up rates across states, and the modest and variable associations between 7-day follow-up and overdose make it likely that unmeasured confounders were present in these analyses. Policymakers and health plans may be better served by quality measures of timely receipt of MOUD following OUD-related ED visits.

Joseph Merrill, MD, MPH

Reference: Medicaid Outcomes Distributed Research Network. Follow-up after ED visits for opioid use disorder: do they reduce future overdoses? J Subst Abuse Treat. 2022;142:108807.