Harm Reduction, Medication-Assisted Treatment Key to Reducing Opioid-Associated ED Visits: Refat Rasul Srejon, MPH

Refat Rasul Srejon, MPH, continues his conversation with The American Journal of Managed Care® by expanding on findings from his study, "ACA Dependent Coverage Extension and Young Adults' Substance-Associated ED Visits."

He discusses why the Affordable Care Act (ACA) dependent coverage expansion may have contributed to declines in alcohol-associated emergency department (ED) visits among young adults, whereas opioid-associated ED visits remained unchanged. Srejon also offers policy and intervention recommendations aimed at reducing opioid-related ED visits.

Watch part 1 for more on the study's background and key results.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What factors might explain the decline in alcohol-associated ED visits while opioid-associated visits remained unchanged?

There are several possible factors. First of all, I'd like to talk about how alcohol-related problems may be more sensitive to outpatient counseling, brief intervention, or primary care access, which is probably facilitated by insurance.

The second factor could be opioid harms during the study period, driven by changes in supply and overdose dynamics that maybe insurance alone cannot quickly modify.

Another factor would be that [substance use disorder (SUD)] treatment capacity and stigma differ by substance. Opioid users may face greater barriers to effective treatments, even if insured. The last one, probably, is differential help-seeking or coding practices could play a role, as well.

What policy or intervention strategies could help reduce opioid-related ED visits among young adults?

Insurance expansion should be paired with targeted strategies, like expanded Medicaid or Medicare variety for medication-assisted treatment. Also, incentivize primary care clinicians to provide medication for opioid use disorder and increase harm reduction services, such as naloxone distribution or syringe services.

We can also integrate SUD treatment into emergency departments and invest in more workforce training and stigma reduction. Data-driven outreach and youth-tailored engagement models are also crucial, I think, for this topic.