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Call for Improved Treatment for Substance Use Disorder

By: Lucy Connery MPH

The opioid crisis continues to present challenges for communities across the United States. Over 100,000 individuals died from overdose in 2021, which was a 14% increase from 2020 (Centers for Disease Control and Prevention, 2023). One way to address opioid and substance use disorders is by improving access to treatment and resources within communities. Traditionally, emergency departments (EDs) have been at the ‘front-line’ of the opioid crisis, often responding to opioid overdoses and treating individuals who present for symptoms of withdrawal. Between 2014 and 2018, 1 in every 11 ED visits consisted of individuals with substance use disorder (Suen, Makam, Snyder, Repplinger…& Nguyen, 2022). It is vital that hospitals and emergency departments are equipped with resources to address opioid and substance use disorders, including resources to refer these individuals to treatment upon discharge.

However, many individuals with substance use disorder (SUD) do not complete their treatment at the hospital and leave against medical advice (AMA). Between 2016 and 2020, about 17% of patients with opioid use disorder left the hospital before their care team deemed it safe (Thakrar, Lowenstein, Greysen, & Delgado, 2023). Research shows that individuals with SUD leave the hospital AMA for a variety of reasons, such as not having their withdrawal symptoms treated or feeling isolated due to stigma and discrimination from health care providers (Simon, Snow & Wakeman, 2020; Wolkow, 2020). Withdrawal symptoms can be treated with various analgesics or medications for opioid use disorder (MOUD) like buprenorphine and methadone. In fact, studies have shown that MOUDs are effective in treating withdrawal and reducing AMA-discharges. However, many medical professionals lack training in treating SUD and these medications are rarely initiated in the hospital (Sokolski, Buchheit, Desai & Englander, 2023; Thakrar, Lowenstein, Greysen, & Delgado, 2023). Feelings of stigma and discrimination may also stem from policies that marginalize or discriminate against individuals with SUD. Such policies may include limiting visitation, restrictions on meals or snacking, or punitive consequences like isolation or security assignments (Martin, Snyder, Otway, Holpit, Day & Seidman, 2023).

The inefficiencies in how our health care system addresses SUD out of the hospital have serious implications on communities across the United States. Patients leaving the hospital AMA are at increased risk for re-admission and death within 30 days of their visit (Glasgow, Vaughn-Sarrazin, & Kaboli, 2010; Simon, Snow & Wakeman, 2020). Individuals presenting to the emergency department post-overdose or due to withdrawal can be a very sensitive time for patients. It is important to connect individuals with SUD to resources and treatment options available to them at the moment they are ready. It is vital for hospitals and emergency departments to link individuals with SUD to outpatient, community-based treatment for long-term access to medications for addiction treatment.

Medication for Addiction Treatment and Electronic Referrals (MATTERS) offers a rapid referral platform that is accessible on any electronic device. Both medical and non-medical professionals can submit referrals to outpatient treatment in less than 5 minutes, connecting individuals to several barrier-reducing resources. These resources include medication vouchers to cover the cost of up to 14 days of oral buprenorphine for the uninsured; transportation vouchers to cover the cost of a round-trip ride for an individual’s first clinic appointment; and a peer referral to support individuals in their recovery journey. Additionally, MATTERS has developed a suggested protocol with prescribing guidelines for first-time prescribers of buprenorphine to improve access to MOUDs.

Organizations interested in joining the rapid referral network should contact the MATTERS outreach team to start submitting, receiving, or supporting referrals for opioid use disorder. Learn more about how MATTERS addresses opioid and substance use disorder, visit


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