Reflections

In facilitating this expert panel and organizing outputs, we were prompted to reflect more broadly on the role of emergency medicine, as a field, and as individual physicians, in health system-level interventions aimed at improving outcomes for patients with OUD.

First, the breadth of backgrounds and experiences among panel experts is a testament to how widely patients with OUD are spread across the health system. Despite working with and caring for this patient population, many panel members had not collaborated prior to this exercise. Without coordination, efforts risk becoming decentralized and siloed, consistent with the observation of poor standardization of care across the health system. Cross-departmental collaboration is necessary to implement meaningful, lasting interventions that impact patient populations who span care settings. Though patients with OUD are one such example, the same lesson could be applied to similar transient populations, including patients with sickle cell disease or chronic pain, or those who are incarcerated or pregnant.

No clear single stakeholder owns this work. As a result, the need for leadership—including organization and coordination of ongoing and future efforts—is evident. We propose that emergency physicians could lead it. Emergency medicine leadership for addiction care at the patient, institutional, health system, and national level is both practical and morally imperative. Interventions stemming from this expert panel will benefit emergency physicians directly and indirectly; they fill gaps in knowledge by increasing access to addiction-trained subspecialists and improve connectivity to outpatient care that may result in decreased ED utilization and re-visit rates for this patient population. The ED is often the first and only touchpoint to the health system for vulnerable, stigmatized, and marginalized patients such as those with OUD. We are unique in our frontline perspective and accessibility to both the prevalence and extreme consequences of this disease. This gives emergency physicians the opportunity and obligation to lead in health system-level interventions seeking to improve the care of those with OUD.

Acknowledgments

The authors would like to graciously acknowledge Joan Esbri-Cullen, BS, director of special projects and associate director of the emergency medicine service line at the Mount Sinai Health System, and Andy Jagoda, MD, professor and system chair emeritus of emergency medicine at the Icahn School of Medicine at Mount Sinai, for their dedication to creating a space for the expert panel described in this article. Additional funding for hosting the panel was provided by Indivior.