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The following is a summary of “Evaluation of Barriers and Interventions for Emergency Department-Initiated Naltrexone for the Treatment of Alcohol use Disorder,” published in the January 2025 issue of Emergency Medicine by Covarrubias et al.
Despite the effectiveness of naltrexone in reducing alcohol consumption when initiated in the emergency department (ED) for alcohol use disorder (AUD), its utilization remains low despite impacting 100 million people globally.
Researchers conducted a retrospective study to identify barriers faced by clinicians and individuals when considering naltrexone initiation in the ED and explore interventions to enhance its prescription.
They used contextual inquiry to observe ED workflows and conducted open-ended interviews with clinicians, staff, and individuals (November 2023) to explore barriers to initiating medications for AUD. In March 2024, they distributed a mixed-method survey to 160 staff members at the University of Pennsylvania Health System, achieving a 61% response rate. The survey measured comfort with AUD treatment aspects and evaluated the impact of potential interventions using a 10-point scale.
The results showed significant barriers, including the lack of an AUD screening protocol, limited clinician awareness of treatment options, and a tendency to postpone non-urgent care. Individuals reported discomfort in ED settings, unfamiliarity with treatment options, and difficulty accessing follow-up care. Clinicians were least confident prescribing naltrexone or responding to related questions. Effective strategies identified were introducing a naltrexone discharge order set and utilizing substance use navigators to support ongoing care.
Investigators concluded the under-treatment of AUD in the ED from multifaceted barriers, necessitating educational interventions for both patients and clinicians and a simplified and streamlined treatment initiation process.
Source: jem-journal.com/article/S0736-4679(25)00015-0/abstract
