Exploring Preferences in Emergency Department Coordination of Opioid Use Disorder Treatment by Race and Ethnicity

Significant racial and ethnic disparities exist in treatment referral engagement for opioid use disorder (OUD) after an emergency department (ED) visit. Little is known about how contextual factors influence preferences for ED OUD treatment coordination and how these preferences vary by race and ethnicity. This study seeks to evaluate and compare structural and support-related factors by eliciting ED OUD treatment coordination preferences among Black, Hispanic, and White individuals with OUD.

Two trained qualitative investigators conducted semi-structured telephone individual interviews with 57 participants (20 non-Hispanic Black, 20 non-Hispanic White, 17 Hispanic) formerly enrolled in Project ED-Innovation. We used the National Institute on Minority Health and Health Disparities Research Framework to explore preferences in ED OUD treatment coordination and how they may be shaped by structural and support-related factors. Participants were recruited using purposeful sampling from eight ED sites: Cooper (NJ), Grady Memorial (GA), Henry Ford (MI), Maine (ME), University of New Mexico (NM), University of Utah, and the Alameda Health System (CA). Transcript were categorized and analyzed by race and ethnicity.

Black participants emphasized relational encouragement as a facilitator of treatment engagement. Hispanic and White participants described difficulty navigating a two-tiered racialized treatment system: methadone and buprenorphine. Participants from all three groups emphasized: (1) recognition and appreciation of hospitals' efforts in providing ED-initiated buprenorphine; (2) the importance of ED addiction care efficiency; (3) value of demonstrating compassion during conversations about OUD; (4) enhancing accessibility of OUD treatment post-ED visit.

Black participants underscored relational encouragement as a facilitator of engagement, while Hispanic and White participants described difficulty navigating a two-tiered OUD treatment system. All groups supported ED-initiated buprenorphine; however, they noted a need to improve accessibility post-ED visit. Future ED-based studies should integrate these contextual factors to develop models that improve OUD treatment engagement among all populations post-ED visit.