Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Alcohol use disorder (AUD) contributes to significant healthcare costs, disease, emergency department (ED) crowding, and recidivism. Naltrexone is a treatment for AUD that has been approved by the U.S. Food and Drug Administration and holds promise as a pharmacologic intervention for ED patients with AUD. We hypothesized that subjects who received naltrexone in the ED would have associated reduced recidivism in the 30 days after treatment.

Methods: This was a retrospective chart review of an AUD quality program comparing ED visits in the 30 days before with 30 days after initiation of naltrexone in the ED. We performed this study at two academic hospitals (one a Level I trauma center) and one community hospital.

Results: A total of 297 subjects (median age 43 years, 69.5% male) made 331 naltrexone index visits during the study period. There was no difference in the number of ED visits before versus after the index visit among all subjects (0 median visits before [interquartile range 0-1] versus 0 median after [0-1]). Subjects who were frequent ED users (defined as ≥ 4 ED visits in the 90 days preceding (N=56 [16.9%]) had a significant reduction in ED visits after administration of naltrexone (median of 5 visits [3-8] before versus 3 [2,6] after), with 36 of these subjects (64.3%) having reduced ED visits in the 30 days after naltrexone administration.

Conclusion: Naltrexone administered in the emergency department had no associated change on the study population’s rates of recidivism for alcohol use disorder, but it was associated with reduced ED recidivism in subjects with high ED use.