Using a Novel Measure to Define Trends in Opioid Use Disorder-Related Emergency Care

The ongoing opioid overdose epidemic underscores the need to monitor key emergency department (ED) interventions such as medications for opioid use disorder (MOUD; i.e., buprenorphine or methadone) and take-home naloxone. However, tracking these practices is limited by a lack of timely, accurate, and automated measures. We aimed to develop three novel ED opioid care metrics and apply them in a large national ED registry to identify trends in opioid-related care.

We used data from the American College of Emergency Physicians’ Clinical Emergency Data Registry (CEDR), a national ED registry of 51,948,120 visits from approximately 650 EDs during January 2023 to September 2025. Eligible encounters were those with opioid-related diagnosis codes, defined by expert consensus. We defined three metrics: a) MOUD administration in the ED; b) buprenorphine prescribed at ED discharge; and c) take-home naloxone provided (prescribed or dispensed). For each metric, we determined the overall percentage of eligible visits and examined quarterly trends via linear regression.

There were 264,738 visits that met inclusion criteria for an opioid-related encounter (0.5% of all registry visits). Over the 33 months of the study, for eligible diagnosis codes: a) administration of MOUD in the ED was 15.7%; b) prescription of buprenorphine at discharge was 10.2%; c) prescription or dispensation of naloxone was 18.0%. Linear regression of quarterly rates demonstrated significant increases in ED MOUD administration (+1.2% per quarter, 95% CI 0.99-1.42) and naloxone provision (+0.3% per quarter, 95% CI 0.06-0.43), while buprenorphine prescribing at discharge showed no significant change (+0.04% per quarter, 95% CI -0.12-0.20).

Implementation of ED-based opioid-related measures is feasible on a large scale. These standardized measures can enable routine tracking of ED practice patterns, highlighting improvements and gaps over time. Our findings show that ED use of MOUD and naloxone remains suboptimal but is increasing.