• Erik S Anderson, Mac Chamberlin, Marisa Zuluaga, Monish Ullal, Kathryn Hawk, Ryan McCormack, Gail D'Onofrio, and Andrew A Herring.
• Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, CA; Department of Medicine, Substance Use Disorder Program, Highland Hospital-Alameda Health System, Oakland, CA. Electronic address: esanderson@alamedahealthsystem.org.
• Ann Emerg Med. 2021 Dec 1; 78 (6): 752-758.

Study ObjectiveDespite evidence supporting naltrexone as an effective treatment for alcohol use disorder, its use in emergency department (ED) patients has not been described. We implemented a protocol that combined substance use navigation with either oral naltrexone or extended-release intramuscular naltrexone for patients with alcohol use disorder as a strategy to improve follow-up in addiction treatment after ED discharge.MethodsIn this descriptive study, we analyzed the results from adult patients discharged from the ED with moderate to severe alcohol use disorder who received either oral naltrexone or extended-release intramuscular naltrexone between May 1, 2020, and October 31, 2020, and assessed their engagement in formal addiction treatment within 30 days after discharge from the ED.ResultsAmong 59 patients with moderate to severe alcohol use disorder who accepted naltrexone treatment, 41 received oral naltrexone and 18 received extended-release intramuscular naltrexone. The mean (SD) age of the patients was 45.2 (13.4) years; 22 patients (37.3%) were Latinx, 18 (30.5%) were Black, and 16 (27.1%) were White. Among all patients, 9 (15.3%) attended follow-up formal addiction treatment within 30 days after discharge; 5 patients (27.8%) who received extended-release intramuscular naltrexone and 4 patients (9.8%) who received oral naltrexone attended follow-up treatment within 30 days.ConclusionWe implemented a clinical protocol for ED patients with moderate to severe alcohol use disorder using oral naltrexone and extended-release intramuscular naltrexone together with substance use navigation. Identification of alcohol use disorder, a brief intervention, and initiation of naltrexone resulted in a 15% follow-up rate in formal addiction treatment. Future work should prospectively examine the effectiveness of naltrexone as well as the effect of substance use navigation for ED patients with alcohol use disorder.Copyright © 2021 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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