Emergency Department-based Opioid Harm Reduction: Moving Physicians From Willing to Doing

Area of Science:

• Emergency Medicine
• Public Health
• Addiction Medicine

Background:

• Opiate harm reduction (OHR) interventions are crucial for mitigating overdose deaths and associated harms.
• Translating physician willingness to perform OHR interventions into clinical practice remains a challenge.

Purpose of the Study:

• To develop and validate a survey tool assessing emergency department (ED) physician attitudes, practices, and willingness regarding OHR interventions.
• To identify barriers and facilitators influencing the implementation of OHR interventions by ED physicians.

Main Methods:

• An anonymous, web-based survey was administered to ED physicians at three tertiary referral centers, utilizing the Theory of Planned Behavior.
• Survey questions were validated using principal component and Cronbach's alpha analyses.
• Stepwise linear regression identified factors impacting willingness to perform OHR interventions, including opioid overdose education and naloxone prescribing.

Main Results:

• 71.9% of physicians completed the survey, indicating willingness to perform OHR interventions, though actual practice was limited.
• Physician willingness correlated with attitude, confidence, and self-efficacy (R² = 0.50), but confidence levels were moderate (mean=3.06/5).
• Key barriers included lack of knowledge, time, training, and institutional support, while research evidence and leadership endorsement were facilitators.

Conclusions:

• Emergency medicine physicians demonstrate greater willingness for OHR interventions compared to previous studies, yet a gap persists between willingness and practice.
• Disseminating research evidence, gaining professional organization endorsement, and securing ED leadership support are vital.
• Addressing practical barriers such as time constraints, knowledge gaps, and institutional support is essential to enhance OHR intervention implementation.