An Institutional Provider Survey Evaluating Access and Implementation of Opioid Use Disorder Treatment in the Intensive Care Unit

OBJECTIVES: Patients with opioid use disorder (OUD) are increasingly admitted to intensive care units (ICUs) due to complications stemming from undertreated OUD. Rural hospitals are disproportionately affected. Hospitalization represents a critical opportunity to initiate OUD treatment; however, no ICU-specific guidance exists. We conducted a survey to assess the knowledge and practices of providers caring for patients with OUD in critical care settings, focusing on differences between rural and urban hospitals. METHODS: We conducted a survey of providers in 9 ICU and acute care units at MaineHealth, the largest integrated health system in northern New England, from April to December 2024. Survey domains included access to addiction services, medications for OUD (MOUD) utilization, buprenorphine prescribing knowledge, and naloxone prescribing. Differences were assessed using the χ2 or Fisher exact tests. RESULTS: Fewer than half of respondents (46.2%) felt adequately supported to manage OUD. Methadone and buprenorphine were always continued in only 10% and 8.6% cases, respectively. A total of 30.0% of respondents correctly identified that any provider with Schedule III authority can prescribe buprenorphine. Fewer rural providers reported access to consultative OUD teams (39.3% vs. 70.0%, P=0.023) but were more likely to prescribe naloxone (71.4% vs. 35.9%, P=0.013). Overall, 69.2% indicated that naloxone was rarely or never prescribed to patients at the time of self-directed discharge. DISCUSSION: Our survey identified that both rural and urban hospitals reported low rates of MOUD utilization and knowledge gaps regarding buprenorphine prescribing. These findings reinforce the need for system-level efforts to expand access to MOUD and improve provider education across intensive care settings.