{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T16:00:28Z","timestamp":1778860828613,"version":"3.51.4"},"reference-count":33,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R25DA058490"],"award-info":[{"award-number":["1R25DA058490"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcohol, Clinical and Experimental Research"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Excessive alcohol use is a leading cause of preventable death in the United States, with the emergency department (ED) serving as a critical touchpoint for individuals with alcohol use disorder (AUD). Despite clinical guidelines recommending initiation of medication for AUD (MAUD), such as naltrexone, ED prescribing remains rare. The objective of this study is to characterize clinician naltrexone prescribing practices for ED patients with hazardous drinking or AUD and identify patient\u2010 and encounter\u2010level predictors of naltrexone prescribing within a large, integrated health system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of adult ED encounters across 12 hospitals from 2022 to 2024. Eligible encounters included patients with a positive Alcohol Use Disorders Identification Test\u2010Consumption (AUDIT\u2010C) screen, indicating hazardous alcohol use or an active AUD, who had no exclusion criteria contraindicating naltrexone and were discharged from the ED. The primary outcome was provision of a naltrexone prescription at ED discharge, and the secondary outcome was prescription fill. We used a multivariable logistic regression model with generalized estimating equation (GEE) to identify predictors of prescribing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 52,701 treatment\u2010eligible ED encounters, only 0.5% resulted in a naltrexone prescription. Prescriptions were more likely in encounters involving younger, male patients with higher AUDIT\u2010C scores, alcohol\u2010related complaints, and those occurring at an academic ED. In the logistic GEE model, academic setting, alcohol withdrawal diagnosis, and greater alcohol misuse severity were independently associated with increased prescribing. Nearly half (45%) of ED naltrexone prescriptions were filled.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Naltrexone prescribing among treatment\u2010eligible patients is rare. Encouragingly, nearly half of patients receiving a prescription proceeded to fill it, highlighting a promising opportunity for ED\u2010based prescribing of naltrexone to initiate AUD treatment. To improve AUD care, systematic ED\u2010based strategies are urgently needed that go beyond universal screening to address barriers to MAUD initiation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.70145","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T15:00:27Z","timestamp":1759158027000},"page":"2310-2318","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Predictors of naltrexone prescribing for alcohol use disorder from the emergency department"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1553-3363","authenticated-orcid":false,"given":"Jacob A.","family":"Lebin","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin","family":"Hensen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics, Colorado School of Public Health University of Colorado  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhixin","family":"Lun","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics, Colorado School of Public Health University of Colorado  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bethany M.","family":"Kwan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Colorado School of Medicine  Aurora Colorado USA"},{"name":"Adult &amp; Child Center for Outcomes Research &amp; Delivery Science University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth M.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9945-0284","authenticated-orcid":false,"given":"Ellen L.","family":"Burnham","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason A.","family":"Hoppe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2016.01.005"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2017.7.34373"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2008.01.325"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14911"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.158.16.1789"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/acer.14837"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2025.01.001"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.15059"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ALC.0000164374.32229.A2"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14860"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadr.2022.100049"},{"key":"e_1_2_11_13_1","first-page":"34","article-title":"Measuring community vulnerability to natural and anthropogenic hazards: the Centers for Disease Control and Prevention's Social Vulnerability Index","volume":"80","author":"Flanagan B.E.","year":"2018","journal-title":"Journal of Environmental Health"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14758"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.15093"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-018-0117-1"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2022.11.013"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14668"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agu098"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2023.03.033"},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","unstructured":"McPheeters M. 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