For people living with addiction and opioid use disorder (OUD), emergency departments are often the first—or only—place to turn. Emergency physicians are accustomed to treating patients during overdoses and withdrawal, but increasingly, they are also proving that the emergency department can be the starting point for recovery.

ACEP’s Emergency Quality Network (E-QUAL) is a practice-based learning network designed to support emergency departments in enhancing the care they provide to patients through structured guidance and evidence-informed tools and resources. Through E-QUAL, ACEP has been working with emergency departments across the country to expand evidence-based treatment for OUD. E-QUAL’s Building Opioid Use Disorder and Overdose Support and Training (BOOST) program accelerates that work through hands-on guidance and tailored support. The program pairs local physician champions with experienced BOOST leaders who provide education and real-time feedback as the champions build and refine their addiction care programs.

“One of the biggest challenges in implementing programs to care for patients with opioid use disorder is that many clinicians were never initially trained to use these medications,” said BOOST co-principal investigator Kathryn Hawk, MD, MHS. “The most important thing for helping to build these programs is to provide education, training protocols, and standardization.”

BOOST is supported by funding from the Foundation for Opioid Response Efforts, which has partnered with ACEP on several initiatives aimed at improving addiction and OUD care in emergency settings.

Building Clarity in the ED

Katie Sprinkel, MD, an emergency physician and medical director at HCA HealthONE Aurora in Colorado, has long understood the ED’s unique role in addiction care.

“People that may not have the resources, ability, or opportunity to get care elsewhere—whether it be for addiction, primary care, or pain management—come to the emergency department,” she said. “We have a unique opportunity because we see them when they’re not able to see any other medical professionals.”

Before joining the BOOST program, her department had already begun distributing naloxone and initiating buprenorphine treatment, but the practice varied from clinician to clinician. Some uncertainty remained about whether, when, and how to start medication for OUD.

BOOST leaders met with Dr. Sprinkel’s group to walk through complex cases and refine treatment pathways. In time, her team expanded protocols for home buprenorphine initiation and updated their algorithms to reflect evolving evidence. “The BOOST program was a win-win, to get advice and perspective from experts in the field. They were able to say, ‘Here’s what worked for me in that scenario,’” Dr. Sprinkel said.

A powerful reminder of her department’s success in improving OUD care came when a patient who had once been a frequent visitor to her ED for addiction-related issues returned to speak about her recovery. “She said she remembered people treating her like a human, treating her with kindness. That gave me the long view that people do get better,” Dr. Sprinkel said. “We just need to keep the door open so they feel comfortable coming to us when they are ready.”

Moving from Passion to Action

Mary McCumber, DO, is an emergency physician and medical director at Holy Cross Hospital Salt Lake in Utah. Despite her passion for improving addiction care, her attempts to enhance OUD treatment programs at her hospital faced slow progress and bureaucratic hurdles.

“I was looking at how to build it, seeing what we could do, but it was a lot of work and I was making slow progress,” she said.

Dr. McCumber’s experience is common, BOOST program leaders shared. “Nearly every emergency department has someone that is interested in this. They want to move the work forward. They’re passionate about it,” said BOOST co-principal investigator Scott Weiner, MD, MPH. “Often what they need is some credibility and resources. Having BOOST come in, and being part of ACEP, it’s powerful.”

With guidance from BOOST leaders, Dr. McCumber’s group developed clearer workflows, strengthened referral pathways, and increased comfort with initiating medication treatment directly from the ED.

According to Dr. McCumber, one of the most significant outcomes was overcoming some of the old stigmas of addiction. “Unfortunately, not so long ago, we were taught that people made these choices themselves,” she said. “I was able to educate care teams in the ED to help them understand the pathophysiology of the addiction, and how there does get to be a point when the patient really wants to stop, but physiologically in their brain they can’t.”

Like Dr. Sprinkel, Dr. McCumber’s work was rewarded when she saw patients move into recovery. “When you see the ones that have done it, it’s exciting, they can start over and build a life again. It’s a reminder of the humanity in everyone,” she said.

Setting the Standard of Care

As BOOST nears completion (closing June 2026 per grant terms), the program leaders hope that the success seen by Dr. Sprinkel, Dr. McCumber, and the nearly 40 other ED champions in the program will spread as they carry their skills and expertise into other hospitals and communities.

“Our ultimate goal is to make evidence-based treatment the standard of care in every emergency department in the country,” said Dr. Weiner.

Ms. Enser is ACEP’s public relations and content manager.