Community Treatment Retention Following Emergency Department Initiation: Methadone vs Buprenorphine

The Emergency department (ED) is an integral setting to initiate medications for opioid use disorder (MOUD); however, few EDs provide both methadone and buprenorphine. ED buprenorphine initiation is effective, but there is limited data regarding retention following ED-initiated methadone. To address this gap, we compared outpatient follow-up rates with community partners following ED-induction of methadone or buprenorphine.

This is a retrospective cohort examining rates of community outpatient follow-up among adult patients with methadone or buprenorphine inductions during an ED visit from 3/1/2025 to 11/30/2025. In March 2025, a new ED methadone option was added to an existing ED buprenorphine protocol allowing patients to choose their treatment. Both treatments utilize ED social workers to facilitate linkage to outpatient care across multiple, unaffiliated community-based clinics, guided by patient preference. Implementation included provider education via staff meetings and asynchronous presentations. Data was collected from electronic health record analytics and from community treatment partners via REDCap surveys. Attendance at clinic intake and 30-day, 60-day, and 90-day follow-ups were evaluated. Included patients received an ED dose of methadone or buprenorphine. Excluded were guest doses of methadone or bridge scripts (any MOUD in the past 30 days). Chi-square tests were used to compare follow up rates.

45 patients received MOUD ED-induction, 32 (71%) buprenorphine and 13 (29%) methadone. 12% of ED buprenorphine and 75% of ED methadone inductions attended the initial intake appointment (p<0.001). At 30-day, 8% of ED buprenorphine and 62% of ED methadone presented (p<0.001). At 60-day, 9% of ED buprenorphine and 62% of ED methadone presented (p=0.002). At 90-day, 4.5% of ED buprenorphine and 50% of ED methadone presented (p=.005).

Patients who chose ED methadone initiation were more likely to continue community treatment. These early findings highlight the importance of offering both ED methadone and buprenorphine for ED inductions and the need for broader ED methadone induction implementation. Additionally, using community partnerships instead of internal referrals likely improved generalizability. These findings support further evaluation of ED methadone initiation as a potentially important strategy to improve early MOUD retention.