539 - Effectiveness of Automated Screening for OUD in the Emergency Department

Publication Number: 539.4913

Ron L. Kaplan, University of Washington School of Medicine, Seattle, WA, United States; Sarah J. Lowry, Seattle Children's, Seattle, WA, United States; Chris Buresh, Seattle Children's Hospital, Seattle, WA, United States

Background: The emergency department (ED) frequently sees adolescents with drug-related issues, including opioid overdose. Pediatric opioid overdose deaths are rising, with opioid use disorder (OUD) among 12-17-year-olds increasing from 265,000 to 316,000 between 2022-2023. Although self-reported use rates are steady, mortality is climbing. Naloxone (Nal), a medication that reverses opioid overdose, and Buprenorphine (Bup), a treatment proven to reduce withdrawal, cravings, and fatal overdoses, are rarely administered to adolescents in the ED. Screening tools for OUD exist, but are inconsistently used.

Objective: 1) To evaluate the effectiveness of automated screening for OUD in the pediatric ED
2) To estimate the overall incidence of adolescents at risk for harm from opioids in the pediatric ED

Design/Methods: This study retrospectively evaluated an automated OUD screening protocol in a pediatric ED. A best practice alert (BPA) was triggered for adolescents (age 13+) presenting with one of 12 specific chief complaints, prompting providers to screen for overdose risk using CRAFFT 2.0 and HEADSS assessments. Adolescents identified with OUD were offered Bup, and those at risk of overdose were offered Nal. Procedures allowed patients to request confidentiality from parents for these interventions if desired.

Results: Data covering 22.5 months pre-intervention and 11 months post-intervention included 30,747 adolescent visits. Bup was distributed to BPA-eligible patients 0.6 times per month pre-intervention, rising to 2.8 times monthly post-intervention, a 460% increase. Nal administration rose from 1.4 to 7.9 times per month, a 560% increase. Even among non-BPA-eligible patients, Bup prescriptions increased from 3.7 to 9.2 times monthly (250%), and Nal prescriptions rose from 8.1 to 21.4 times monthly (260%). Of the patients that triggered the BPA, 40% got one of the medications compared to 2.4% of the general population of the ED.

Conclusion(s): Chief complaint-based screening effectively increases Bup and Nal administration in the pediatric ED. The incidence of adolescents felt to be at risk for harm from opioids in this population was 2.4%. While further refinement is needed to improve the screening’s sensitivity and specificity, the intervention appears to heighten clinician awareness and increase OUD care, even among patients not directly triggering the BPA.

Bup and Nal Before and After Implementation
Rates of buprenorphine (Bup) and Naloxone (Nal) prescription or dispensation before and after Automated Screening intervention