Trends in Self-Reported Fentanyl and Other Illicit Substance Use in South Carolina Emergency Department Patients, 2020-2022.

BACKGROUND: Opioid-involved deaths are continuing to increase across the United States, exceeding 100,000 for the first time in 2021. Contamination with, and intentional use of, synthetic opioids such as fentanyl are a major driver of this increase. Utilizing self-report substance use data of patients being treated in the emergency department (ED) can be useful to determine which substances patients are intentionally seeking. OBJECTIVES: 1) Examine changes in self-reported illicit substance use (including fentanyl) over time; 2) Examine changes in the co-occurrence of self-reported fentanyl with other illicit substance use over time. METHODS: All patients presenting to the study EDs that answered anything other than "never" on the National Institute on Drug Abuse Quick Screen and were seen by a peer recovery specialist in the ED between July 1, 2020 and December 31, 2022 were included for analysis. The substance of use as reported by each patient was recorded by the peer recovery specialist. Differences in substance use by type over time were examined using chi-squared tests of proportions. RESULTS: There were 7568 patients that met inclusion criteria. Self-reported fentanyl (1760%; p < 0.0001) and cocaine (82%; p = 0.034) use increased, whereas heroin use (16%; p < 0.0001) decreased. CONCLUSIONS: Self-reported fentanyl and cocaine use has increased significantly in South Carolina ED patients between 2020 and 2022. Given the high morbidity and mortality associated with fentanyl and fentanyl analog use, further measures to identify these patients and provide harm reduction and treatment from the ED setting are warranted.

Retention in Treatment after Emergency Department-Initiated Buprenorphine.

BACKGROUND: Emergency department-initiated buprenorphine (EDIB) has been shown to be effective in connecting patients with opioid use disorder (OUD) to outpatient treatment. Five diverse emergency departments (EDs) have successfully implemented EDIB programs. OBJECTIVES: 1) To measure attendance at the first referral appointment and 30-day retention in treatment rates for patients receiving EDIB; 2) To describe demographic and opioid use characteristics of patients receiving EDIB; and 3) To determine average length of time in treatment after EDIB at the five participating EDs. METHODS: All patients receiving EDIB at the participating EDs (n = 522) were seen by a peer recovery specialist in the ED and demographic and opioid use characteristics were recorded. Patients were followed prospectively. The referral site was contacted and information regarding attendance at the first referral appointment and 30-day retention in treatment was obtained. All patients still in treatment at 30 days were continually followed at subsequent 30-day intervals until the referral site indicated the patient had ended treatment at their facility. RESULTS: The rate of attendance at the first referral appointment was 77.0% for patients receiving EDIB. At 30-day follow-up, 43.1% of patients were retained in treatment. The mean age of patient enrollment was 36.7 years, 58% of enrollees were male, 90.5% were white, and 73.4% had no medical insurance. Seventy-seven percent reported no substance use other than opioids. The mean time in treatment was 158 days. CONCLUSIONS: EDIB programs across diverse ED settings are effective at promoting attendance at the first referral appointment for OUD treatment; however, additional work is warranted to increase 30-day treatment retention rates, particularly among patients with nonprescription-only use profiles.