A new University of Michigan examination of 100% of Medicaid claims from all 50 U.S. states and Washington, D.C., spanning the years 2016-2020, found an alarming disconnect between overdose treatment and addiction treatment.

Only 6% of people treated for drug overdose in an emergency room entered an addiction treatment program within 30 days of leaving the hospital. They simply are not being offered the medications used to treat substance use disorders. 

The first 30 days is critical for getting someone who is being treated for drug overdose transitioned into a treatment program. Yet the study shows this option is seldom offered. Dr. Thuy Nguyen, assistant professor at the University of Michigan School of Public Health, explained the importance of the 30-day window to News-Medical.Net:

The emergency department offers a critical window of time to initiate [medications for opioid use disorder]. It’s critical because we know that patients who are discharged from the [emergency department] after a nonfatal opioid overdose are at increased risk of experiencing a fatal overdose within the next twelve months.

The study also shows a significant racial disparity in who is offered addiction treatment. Of the nearly 250,000 overdose emergencies analyzed, 69% of the patients were white, 18% were black and 10% were hispanic. Yet white patients were offered addiction treatment most often, at a mere 7.3% of the time, and black patients least often, at 4.3% of the time.

Why is there such a low referral rate from the emergency room to a certified addiction treatment program? For answers, let’s look at a systematic review of physician reluctance to intervene in addiction published by JAMA Network Open last year. They found that nearly three-quarters of the time, emergency room physicians said they lacked the knowledge (74%) or the skills (71%) to intervene.

How is it that nearly three quarters of emergency room physicians who attended to patients experiencing drug overdoses lacked the knowledge or skills to transition the patient into medically-assisted addiction treatment? Another study from Michigan points out that “physicians receive, on average, less than 10 hours of addiction treatment training in medical school.”

There is another reason people are not being transitioned to addiction treatment, what the researchers euphemistically call a “lack of institutional support,” which means an organizational reluctance to get involved. Eighty-one percent of emergency room physicians involved in overdose treatment that ultimately led to later overdose deaths blamed the “institutional environment.”

That “institutional environment” includes the paperwork involved, staff time constraints, lack of medications on hand, need for prior approval, etc. And then, there’s the money consideration:

Physician reimbursement was viewed as insufficient to cover both the staff time necessary to intervene in addiction and the expense of additional staff training.

Dr. Nguyen points out that care providers are being penny-wise and pound-foolish, trying to avoid unreimbursed costs by releasing overdose patients back onto the streets:

Increasing the initiation of opioid addiction medications in the emergency department could also benefit hospitals by preventing patients, many of whom have no primary care doctor, from returning to the [emergency room] for another overdose, thus reducing the strain on an already overwhelmed system.

Written by Steve O’Keefe. First published May 27, 2025.

Sources:

“Study reveals low rate of opioid addiction medications after overdose,” News-Medical.Net, May 12, 2025.

“Physician Reluctance to Intervene in Addiction: A Systematic Review,” JAMA Network Open, July 17, 2024.

“Doctors reluctant to treat addiction most commonly report ‘lack of institutional support’ as barrier,” National Institutes of Health News Release, July 17, 2024.

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