Waiting longer in a hospital's emergency department could encourage people to seek treatment for tjeir opioid use, according to a new retrospective study out of Brown. (Getty Images)
Long wait times in the emergency room often draw frustration from patients. But more time spent waiting to be seen in a hospital emergency department could encourage people with substance use disorder to seek treatment, according to a study published in the July issue of the Rhode Island Medical Journal .
With every extra hour spent in a waiting room, researchers from Brown University observed 12% higher odds that a patient would seek treatment for their drug use.
“One barrier to starting treatment for opioid use disorder that is often reported by patients is feeling stigmatized…when waiting for prolonged times or waiting in very public areas,” Dr. Sarah Arbaugh, the study’s lead author, wrote via email. “We expected to find that increased waiting times led to decreased interest in treatment due to increased exposure to stigmatization.”
“Instead, we found there was a small but statistically significant increase in interest in treatment the longer someone was in the waiting room.”
The new study revisits findings from an earlier controlled study that took place at Rhode Island Hospital, where patients were asked survey questions when they were admitted to emergency departments for an opioid overdose or other complications from their opioid use. The new study is a retrospective analysis of that data and correlates it to longer-term outcomes. A little under half of patients were interested in treatment referrals when they were first surveyed at the hospital. But waiting longer seemed to encourage treatment: Nearly a third of the participants, 201 people in all, sought substance use treatment within 30 days of their ER visit.
The study’s 648 patients who visited emergency departments in two unnamed Rhode Island hospitals from 2018 to 2021 were all at high risk of an opioid overdose. Many arrived by ambulance, and most had current or previous experience with addiction treatment. The longer it took to get a room and the overall duration of the hospital visit both influenced people’s desire to seek treatment. But the study found no significant uptick that correlated to the number of doctors seen or the time it took to see a provider.
Arbaugh, who recently graduated from Brown University’s Alpert Medical School, was joined by four other Brown scholars for the research. Two researchers from Rhode Island’s health and behavioral health departments are also listed as coauthors. State administrative data and patient consent for medical records allowed the researchers to see how many people actually sought treatment after the baseline survey.
The study, Arbaugh said, might highlight the importance of conversations within health care settings about available treatments for opioid use. The Ocean State saw a 7.3% drop in opioid related fatalities but still shows racial and ethnic disparities when it comes to overdose patterns.
“Effective treatments exist, such as buprenorphine and methadone, but we still have work to do to increase engagement in treatment among our emergency department patients and make sure that everyone has access to these treatments,” Arbaugh said. She added that people who don’t have a primary care provider may only see a doctor in emergency situations, which can affect their knowledge about treatment options.
“For people with opioid use disorder, the emergency department is a crucial point of contact because the initiation of substance use disorder treatment in the emergency department decreases mortality,” Arbaugh said.
At the time they sought emergency medical attention, 178 study participants were already in treatment for substance use disorder, and 497 participants had received treatment in the past. Most participants (90%) had health insurance, nearly 70% were unemployed and just under half lacked stable housing in the six months prior to the study.
Study limitations included a reliance on administrative data — which wouldn’t necessarily show whether people actually adhered to their treatment plans — as well as the time it took to discuss treatment itself.
“Time spent connecting patients with SUD [substance use disorder] treatment, [may] contribute to an increased length of stay and thus may contribute to the association between length of stay and interest in treatment,” the study noted.
The motivation to seek treatment is “multifactorial,” Arbaugh said. “It’s possible that people who really want to engage in treatment are willing to wait for long periods to be seen. Likewise, it’s possible that folks who may not know about the treatment options or who aren’t as interested in starting treatment are leaving the ED before being seen.”
Earlier interventions, like discussion of treatment options upon arrival to the emergency department, could help people be more willing to engage in treatment discussions, Arbaugh said.
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