Emergency Department-initiated Naltrexone for Alcohol Use Disorder: Association with Recidivism

Area of Science:

• Emergency Medicine
• Pharmacology
• Addiction Medicine

Background:

• Alcohol use disorder (AUD) presents significant healthcare burdens, including costs, disease, emergency department (ED) crowding, and recidivism.
• Naltrexone is an FDA-approved pharmacologic treatment for AUD with potential utility in the ED setting.

Purpose of the Study:

• To evaluate the effectiveness of naltrexone administered in the ED for reducing recidivism in patients with AUD.
• To test the hypothesis that naltrexone treatment in the ED would decrease 30-day recidivism.

Main Methods:

• Retrospective chart review of an AUD quality program.
• Comparison of ED visits within 30 days before and after naltrexone initiation in the ED.
• Study conducted across two academic and one community hospital.

Main Results:

• A total of 297 subjects (69.5% male, median age 43) had 331 naltrexone index visits.
• No significant difference in ED visits before vs. after naltrexone for the overall study population.
• Frequent ED users (≥ 4 visits in 90 days prior) showed a significant reduction in ED visits post-naltrexone (median 5 visits before vs. 3 after).

Conclusions:

• Emergency department administration of naltrexone did not alter overall recidivism rates for AUD.
• Naltrexone was associated with reduced ED recidivism specifically in patients with a history of high ED utilization.