• Janusz Kaczorowski, Jaunathan Bilodeau, M Orkin Aaron A 0000-0002-1111-8720 the, Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada., Kathryn Dong, Raoul Daoust, and Andrew Kestler.
• From the, Département de Médecine de Famille et Médecine d'Urgence, Université de Montréal, Montréal, Québec, Canada.
• Acad Emerg Med. 2020 Nov 1; 27 (11): 1173-1182.

ObjectivesThe opioid crisis has risen dramatically in North America in the new millennium, due to both illegal and prescription opioid use. While emergency departments (EDs) represent a potentially strategic setting for interventions to reduce harm from opioid use disorder (OUD), the absence of a recent synthesis of literature limits implementation and scalability. To fill this gap, we conducted a systematic review of the literature on interventions targeting OUDs initiated in EDs.MethodsUsing an explicit search strategy (PROSPERO), the MEDLINE, CINAHL Complete, EMBASE, and EBM reviews databases were searched from 1980 to October 4, 2019. The gray literature was explored using Google Scholar. Study characteristics were abstracted independently. The methodologic quality and risk of bias were assessed.ResultsTwelve of 2,270 studies met the inclusion criteria (two of high quality). In addition to the heterogeneity of the outcome measures used (retention in treatment, opioid consumption, and overdose), brief intervention and buprenorphine initiation (six of 12 studies) were the most documented with mixed effects for the former and positive short-term and confined to single ED sites effects for the latter.ConclusionEmergency departments can be an appropriate setting for initiating opioid agonist treatment, but to be sustained, it likely needs to be coupled with community-based follow-up and support to ensure longer-term retention. The scarcity of high-quality evidence on OUD interventions initiated in emergency settings highlights the need for future research.© 2020 by the Society for Academic Emergency Medicine.

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