Management of Opioid Use Disorder in Emergency Departments across Sinai Health System

Introduction: Opioid-related mortality remains a major public health concern, with approximately 76% of overdose deaths involving opioids, according to the CDC (2025). Studies have shown that emergency department (ED) initiation of medications for opioid use disorder (MOUD) improves treatment adherence and reduces morbidity. In Chicago, opioid-related mortality in communities served by Sinai Health System, including North Lawndale (97 deaths per 100,000) and Chicago Lawn (30 per 100,000), far exceeds the national average (15 per 100,000), underscoring the need for system-level interventions. This study evaluates the impact of implementing a pharmacist-developed, ED-specific MOUD order panel designed to standardize opioid withdrawal management, optimize symptom control, and increase appropriate MOUD utilization. The primary objective is to evaluate the impact of changes made to the ED opioid withdrawal management following order panel development and implementation.

Methods: This is a retrospective before-and-after chart review that was conducted across two EDs within Sinai Health System. The baseline analysis included 97 encounters from May–July 2025. An ED-specific MOUD order panel, approved by the Pharmacy and Therapeutics Committee in September 2025, incorporated standardized MOUD dosing, Clinical Opiate Withdrawal Scale (COWS) guided therapy, and supportive medications. This was followed by multidisciplinary ED staff education. In November 2025, the results were presented at the Opioid Stewardship Committee meeting. Post-implementation data is being collected from January–March 2026.

Adults ≥18 years who received methadone or buprenorphine for opioid withdrawal during the study periods were eligible. Encounters required documented COWS assessments. Incarcerated patients were excluded. Data extracted from the electronic health record included MOUD agent, dose, frequency, COWS scores, and rescue medication use. Descriptive statistics will be used to summarize prescribing patterns and withdrawal management practices. IRB is approved under “Management of opioid use disorder in an Urban, Safety Net, Emergency Department” (MSH-IRB-25-28); Milton Childs as the principal investigator.

Results/Conclusion: Post-implementation data collection and analysis are currently underway. Final results will be shared once the data have been compiled, and the conclusion will be presented once analysis is finished.