Advancing Opioid Use Disorder Care in Massachusetts Emergency Departments

Findings Underscore the Critical Need for Improvements & Partnerships

The Massachusetts Department of Public Health Bureau of Substance Addiction Services engaged with JSI to uncover how emergency departments (EDs) across the state manage care for patients with opioid use disorder (OUD). This comprehensive assessment shed light on current practices, challenges, and strategies for improvement—offering a glimpse into the complexities of addressing OUD in a high-pressure environment.

The findings were revealing: while most EDs encounter a significant number of OUD patients, care practices vary widely. Larger hospitals often bear the brunt of higher patient volumes. Around 60% of EDs consistently screen for substance use, yet the availability of life-saving medications, such as naloxone and buprenorphine, is inconsistent. Methadone treatment and take-home starter packs remain rare. Naloxone kits—essential for harm reduction—are not routinely offered to patients, leaving critical gaps in care.

Dedicated support staff, like recovery coaches and social workers, emerged as game-changers in connecting patients to over the long term and fostering trust. Staff members with personal experience of addiction have been especially effective in engaging patients, but many hospitals struggle to secure funding for these vital roles. Similarly, partnerships with mental health and substance use treatment providers can significantly enhance care, yet they are not common outside of larger, well-resourced hospitals.

Despite these efforts, significant hurdles remain. Many ED staff lack training or confidence in managing OUD, and the stigma surrounding addiction continues to undermine care. The fast-paced, acute-care focus of EDs also makes it difficult to initiate the long-term treatments OUD patients need. Compounding these issues, patients often face barriers to follow-up care, from transportation challenges to inadequate financial resources.

The report identifies several opportunities for improvement. Expanded training for ED staff could reduce stigma and equip providers to deliver better care. Offering take-home medications like naloxone and buprenorphine directly from EDs would remove access barriers. Establishing dedicated addiction leadership roles, bridge clinics, and consult services could streamline patient care.

Simplifying grant processes and offering planning grants could empower hospitals and safety-net providers such as community health centers to build their capacity for OUD services.

As primary care providers in underserved areas, Federally Qualified Health Centers (FQHCs) are well-positioned to offer comprehensive, ongoing treatment for opioid use disorder, reducing the need for emergency visits. By coordinating with EDs, FQHCs can serve as critical referral hubs, allowing patients seen in emergency settings to transition into long-term treatment seamlessly. Expanding funding and resources for FQHCs would enable them to strengthen their role in harm reduction, preventive care, and early intervention, ultimately reducing the strain on hospital emergency departments while improving outcomes for individuals struggling with OUD.

By enhancing training, fostering partnerships, and securing resources, ED and community health centers can take on a transformative role—connecting patients with the sustained care they need to rebuild their lives.