Evaluation of Barriers and Interventions for Emergency Department-Initiated Naltrexone for the Treatment of Alcohol Use Disorder

Abstract

Background

Alcohol use disorder (AUD) impacts 100 million people globally and frequently leads to emergency department (ED) visits. Although recent studies have shown that starting naltrexone in the ED can effectively reduce drinking behaviors, it remains underutilized.

Objectives

This study aims to identify the barriers clinicians and patients encounter when considering the initiation of naltrexone in the ED, and the interventions that could promote its prescription.

Methods

Using contextual inquiry, we observed ED operations and conducted open-ended interviews with clinicians, hospital staff, and patients in November 2023 to understand impediments to starting medications for AUD. In March 2024, a mixed-method survey was sent to 160 staff members within the University of Pennsylvania Health System, achieving a 61% response rate. This survey assessed comfort levels with various aspects of AUD treatment and the impact of potential interventions using a 10-point scale.

Results

Findings revealed significant barriers, including the absence of an AUD screening protocol, limited awareness about treatment options among clinicians, and a tendency to defer nonemergent treatments. Patients reported discomfort in ED settings, a lack of familiarity with treatment options, and challenges in accessing follow-up care. Clinicians felt least comfortable prescribing naltrexone and addressing related inquiries. Effective interventions identified included establishing a naltrexone order set for discharging patients and employing substance use navigators to facilitate continuing care.

Conclusion

The study finds that the under-treatment of AUD in the ED is a multifaceted issue that underscores the need to provide educational interventions to both patients and clinicians. Additionally, the results emphasize the need to simplify and streamline the process both clinicians and patients.