Limited Awareness, Protocols Hinder Naltrexone Use in EDs

TOPLINE:

Emergency department (ED) clinicians face multiple barriers in initiating naltrexone for alcohol use disorder (AUD), including a lack of screening protocols and limited treatment awareness.

METHODOLOGY:

• Researchers conducted contextual inquiry observations and open-ended interviews with ED clinicians, hospital staff, and patients in November 2023 to understand impediments to starting medications for AUD.
• A mixed-method survey was distributed to 160 staff members within the University of Pennsylvania Health System in March 2024; 97 responded to the survey.
• The analysis involved evaluating the levels of comfort regarding various aspects of AUD treatment and potential interventions on a 10-point scale.
• Investigators interviewed three attending physicians, two physician assistants, four nurses, one social worker, and six patients during the contextual inquiry.

TAKEAWAY:

• Only three participants (3.1%) prescribed naltrexone at discharge for patients with AUD; 61.9% prescribed benzodiazepines for alcohol withdrawal symptoms, while 10.3% prescribed gabapentin.
• In total, 81.4% of participants felt comfortable identifying patients with hazardous alcohol use or AUD and 84.6% recommended reducing alcohol intake. However, most were not comfortable prescribing naltrexone for AUD (90.8%), answering questions about it (86.6%), or arranging follow-up care (64.9%).
• Key barriers included the lack of a standardized screening protocol, clinician knowledge gaps, reluctance to initiate non-emergent treatments. Patient-reported challenges included discomfort in the ED, unfamiliarity with treatment options, and socioeconomic obstacles to adherence.
• Clinicians gave high ratings to interventions such as standardized prescribing pathways and patient navigation support for improving ED-initiated treatment.

IN PRACTICE:

“In order to close the evidence-practice gap for naltrexone treatment in the ED, initiatives must be implemented to educate patients and care teams and to simplify the process for physicians and patients alike,” the authors wrote.

SOURCE:

The study was led by Ivan Covarrubias, MD, Perelman School of Medicine, University of Pennsylvania, Philadelphia. It was published online on January 23, 2025, in The Journal of Emergency Medicine.

LIMITATIONS:

Limitations included a small patient sample and recall bias. Additionally, researchers missed observations of key processes such as physician handoffs and patient discharges.

DISCLOSURES:

The funding source was not reported. The authors had no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.