Housing Insecurity among Emergency Department Patients with Opioid Use Disorder

Emergency departments (ED) have increasingly engaged in screening and treatment initiation for patients with opioid use disorder (OUD). Patients with OUD, however, may also be impacted by significant social need, including housing insecurity. We sought to consider the incidence of homelessness and housing insecurity in patients engaged in an ED-initiated medication for opioid use disorder (MOUD) program.

We performed a secondary analysis, with specific consideration of housing status, on data obtained from a prospective, ED-initiated MOUD study conducted at an urban, academic hospital, inclusive of enrollments from July 2019-February 2022. We obtained data from participant interviews conducted at study intake and at three months to include the question: "In the past 30 days, where have you been living most of the time?" We used descriptive statistics and Pearson chi-square analyses to assess the data.

Of 315 participants, most were White (79.4 %), male (64.4 %), and between the ages of 25-44 (74.6%). At intake, 66 (20.9%) reported active homelessness, including 44 (14.0%) unsheltered. An additional 157 (49.8%) met criteria for housing insecurity. Men were more likely to be experiencing homelessness (25.1% men reported homelessness vs 13.4% women, P = .01). In contrast, women trended toward housing insecurity more than their male counterparts (45.8% men with housing insecurity vs 57.1% women, P = .05). At three-month follow-up, 141 were able to be reached, with a predominance of housed individuals (118 housed; 46.8%); in contrast only 34.8% of persons experiencing homelessness) (23 participants) were able to follow up at three months (P = .07). Significant differences between sexes noted at intake resolved. No significant differences were found at intake or three months when considering race or age comparisons.

Patients in the ED who are engaged in care for OUD are disproportionately (70.8%) impacted by homelessness and housing insecurity; further, sex may play an exacerbating role. Emergency department-initiated MOUD treatment may have a positive impact on housing status, suggested by this study; however, the study was limited due to large loss to follow-up, especially among those with housing insecurity.