OUD Care Disparities: Racial & Ethnic Inequities in the ED
Addressing Racial & Ethnic Disparities in Opioid Use disorder Treatment Following Emergency Department Visits
Emergency department (ED)-initiated addiction treatment with buprenorphine shows promise, but engagement rates vary. New research highlights crucial racial and ethnic differences in barriers and facilitators to ongoing care, emphasizing the need for culturally responsive interventions.
The ED-Innovation trial & Follow-Up Study
The study,led by Edouard Coupet Jr,MD,MS,of Yale School of Medicine,builds upon the ED-innovation trial,which compared sublingual buprenorphine to a 7-day injectable extended-release formulation across 29 EDs for addiction treatment engagement at 7 days.researchers conducted telephonic interviews with participants to identify obstacles and supports to treatment across racial and ethnic groups.The participant cohort had a mean age of 41.7 years, with 35.1% identifying as women. The sample was diverse: 35.1% Black, 29.8% Hispanic, and 35.1% White. The interview framework combined the National Institute on Minority Health and health Disparities research framework and the theory of planned behavior.
Key Findings: Common Ground & Distinct Experiences
The research revealed both worldwide and group-specific factors influencing treatment engagement. Across all racial groups, participants viewed initiating treatment as a self-driven decision.Common facilitators included positive interactions with ED staff, consistent access to healthcare, and strong social support networks. Conversely, self-stigma, transportation difficulties, mental health concerns, and navigating the complexities of the healthcare system emerged as widespread barriers.
However,significant differences surfaced regarding medication experiences and support systems. White and Hispanic participants frequently expressed concerns about buprenorphine’s taste and potential adverse effects, particularly precipitated withdrawal. Hispanic participants also reported receiving inadequate dosing, while White participants cited unfulfilled formulation preferences and dental issues as challenges.
Social support also varied in importance. Hispanic participants strongly emphasized the role of family support, while Black participants highlighted the value of peer support groups.
A critical finding revealed that Black and Hispanic participants uniquely reported experiences of racism and mistrust toward the healthcare system – experiences occurring outside of their index ED visit – which directly impeded access to addiction treatment.
Implications for Practice: Culturally Responsive Care is Essential
The authors conclude that a “one-size-fits-all” approach to ED-based addiction treatment is insufficient.”Our findings underscore the need for holistic, culturally responsive care to address these distinct racial and ethnic factors influencing addiction care during and after ED visits,” they wrote.
Specifically,the study advocates for:
patient-focused,low-barrier interventions: Greater flexibility in treatment options and reduced administrative hurdles are crucial.
Strong health system & community support: Seamless transitions from the ED to ongoing care require robust coordination. ED-based substance use navigation: Programs designed to help patients overcome structural barriers can substantially improve engagement.
These navigators can assist with appointment scheduling, transportation, insurance issues, and connection to community resources. Addressing systemic racism and building trust within the healthcare system are also paramount.
Study Limitations
Researchers acknowledge several limitations. The study included only English-speaking participants, limiting broader representation. Selection bias may have been introduced by the telephone interview format, potentially excluding individuals without consistent phone access. All participating EDs had prior experience treating opioid use disorder (OUD), potentially limiting generalizability to less experienced facilities. Challenges in matching participants by sex and location due to demographic clustering at some sites, and potential influence of geographic location on structural differences, were also noted.
Funding & Disclosures
The study was funded by the National Institute on drug abuse and Emergency Medicine Foundation.Details regarding author disclosures are available in the original publication.
Source:
Coupet Jr, E, et al. Published online July 14, 2025.JAMA Network Open*. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2836400