Racial and Ethnic Inequities in OUD Care in the ED

TOPLINE:

A new study revealed racial and ethnic disparities in access to opioid use disorder (OUD) treatment after emergency department (ED) visits, with Black and Hispanic individuals facing greater barriers than White individuals.

METHODOLOGY:

• Researchers conducted a qualitative study between 2023 and 2024, involving in-depth telephone interviews with 57 adults with moderate-to-severe OUD who had previously participated in the ED-Innovation trial. The trial compared the effectiveness of sublingual buprenorphine vs 7-day injectable extended-release buprenorphine across 29 ED sites for formal addiction treatment engagement at day 7.
• Participants had a mean age of 41.7 years, and 35.1% were women. Of these, 35.1% were Black, 29.8% were Hispanic, and 35.1% were White.
• The telephonic interviews were developed using a combination of two frameworks: The National Institute on Minority Health and Health Disparities research framework and the theory of planned behavior.
• The outcome was the identification of barriers and facilitators at both behavioral and healthcare system levels associated with OUD treatment engagement across racial and ethnic groups.

TAKEAWAY:

• Key facilitators included positive interactions with ED staff, stable access to healthcare, and supportive social networks, whereas common barriers included self-stigma, transportation issues, mental health concerns, and difficulty navigating the healthcare system. All racial groups acknowledged treatment initiation as a self-driven decision.
• White and Hispanic participants expressed concerns about buprenorphine’s taste and adverse effects such as precipitated withdrawal, whereas Black participants did not share these concerns. Additionally, Hispanic participants reported inadequate dosing, and White participants noted unfulfilled formulation preferences and dental issues.
• Hispanic participants especially emphasized family support, whereas Black participants highlighted peer social support groups as crucial factors for treatment engagement.
• Black and Hispanic participants uniquely reported experiencing racism and mistrust toward the healthcare system outside their index ED visit, leading to barriers in accessing addiction treatment.

IN PRACTICE:

“Our findings underscore the need for holistic, culturally responsive care to address these distinct racial and ethnic factors influencing addiction care during and after ED visits,” the authors wrote. “ED-based interventions should be patient-focused and low barrier (ie, greater flexibility) and should have strong health system and community support. ED substance use navigation, a program designed to help ED patients navigate structural barriers, is one potential solution,” they added.

SOURCE:

The study was led by Edouard Coupet Jr, MD, MS, Yale School of Medicine, New Haven, Connecticut. It was published online on July 14, 2025, in JAMA Network Open.

LIMITATIONS:

Only English-speaking participants were included, limiting broader representation. Selection bias may have occurred due to the telephone interview format, potentially excluding individuals with disconnected phones or limited availability. All sites had prior experience in treating individuals with OUD, potentially limiting generalizability to less experienced settings. Matching by sex and location was challenging due to demographic clustering at some sites. Geographic location may have contributed to structural differences, potentially influencing responses.

DISCLOSURES:

The study was funded by the National Institute on Drug Abuse and Emergency Medicine Foundation. Some authors reported having financial or other ties with various sources. Further details are provided in the original article.

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