Association for Public Policy Analysis & Management

Objective: Practitioners' attitudes and openness to deliver effective opioid use disorder (OUD) interventions in urban emergency departments (ED) is a significant barrier to responding to the opioid epidemic. This study examined the relationship between key organizational capacity factors and practitioners' attitudes about opioid users and practices to initiate OUD treatment in the largest ED in California.

Methods: We relied on logistic regressions to analyze data collected from 240 ED practitioners in 2017. Independent variables included ED leadership, innovation, readiness for change and team psychological safety. Outcomes included measures on ED practitioner’ support for initiating OUD treatment in the ED, best OUD treatment practices and self-efficacy, and practitioners’ bias toward drug users. We accounted for practitioner's demographics, experience and role.

Findings: Compared to ED physicians, nurses were more likely to support OUD treatment in the ED, as well as implementing best OUD treatment practices. However, nurses reported higher bias that physicians towards working with patients suffering from OUD. Organizational measures, such as climate for innovation and readiness for change were positively associated with initiating OUD treatment and using best practices.

Implications: Findings have implications for improving health care responses to opioid epidemics in large metropolises. Policy interventions should suggest customized training for practitioners based on role. Policy interventions can also target practitioners' work context to increase readiness and openness to implement evidence-based treatment practices in the ED and help reduce the burden of the opioid epidemic.