Rates and Disparities in Emergency Department Treatment of Alcohol Use Disorder

Background: Alcohol Use Disorder (AUD) remains the third leading cause of preventable death in the United States. Yet, AUD continues to be undertreated. Medication-assisted treatment (MAT) prescribed in the Emergency Department (ED) has demonstrated efficacy in treating other substance use disorders, prompting recommendations for treatment of AUD as well. Our objective is to identify the prevalence of MAT initiation for AUD during ED visits, as well as demographics and concurrent diagnoses that influence treatment initiation.

Methods: This study is a cross-sectional analysis utilizing the Cerner Real World Health database. Patients diagnosed with AUD presenting to the ED between August 2015 to August 2022 were identified using ICD-10 and ICD-9 codes (F10, 303.90). Individuals with a history of opioid use disorder were excluded. The analysis compared the treatment group (TG) of AUD patients who initiated naltrexone (NTX) treatment, with the non-treatment group (NTG) of AUD patients who did not initiate NTX treatment. Analysis encompassed gender, race, diagnoses, and prescribed medications. Our predetermined α level was .05. Statistical analyses were conducted using chi-square testing via IBM SPSS software.

Results: 479,548 patients diagnosed with AUD presented to the ED in the study period. The NTG consisted of 476,881 patients and the TG 2,667. There was association between race and initiation of NTX (x24=123.5, p<.001). Whites were more represented in the TG compared to the NTG (68.6% vs 63.4%). Blacks (4.6% vs. 10.5%), Hispanics (0.7% vs. 1.7%), and Asians (0.5% vs. 0.9%) were less represented in TG compared to NTG. Native Americans had no difference between TG and NTG (5.1% vs. 4.8%, x21=0.6, p=.435). There was an association between diagnoses and initiation of NTX (x211=1261.2, p<.001). The TG demonstrated higher rates of alcohol dependence (44.3% vs 19.2%), suicidal ideation (40.1% vs 13.0%), withdrawal symptoms (27.8% vs 12.2%), major depressive disorder (26.5% vs 10.1%), anxiety (17.2% vs 9.5%), and blood alcohol level > 240 mg/100 mL (12.1% vs 10.2%) compared to NTG. Gender, nicotine dependence, abdominal pain, and nausea were similar between groups.

Conclusions: Initiation rates of MAT for AUD in the ED are influenced by specific diagnoses and reveal disparities across racial groups. Future interventions should tailor treatment protocols for AUD in the ED, considering these identified patterns.