Emergency medicine physicians were trailblazers during the opioid epidemic, and now we have the same opportunity with alcohol use disorder (AUD). Treating AUD deserves the same attention we give to opioid overdose, diabetic ketoacidosis, or hypertensive emergencies. Even when alcohol use doesn’t present as an immediate crisis, each ED encounter is a chance to intervene—one that could help prevent future withdrawal, traumatic injury, or upper gastrointestinal bleed. Naltrexone and other Medications for Alcohol Use Disorder (MAUD) can reduce alcohol use, and just 12 patients need to be treated to prevent one from returning to heavy drinking. By recognizing alcohol use disorder as a critical health issue and leveraging simple, evidence-based tools, emergency physicians can transform routine encounters into life-changing opportunities.
Initiating MAUD in the Emergency Department (ED) is feasible and impactful. Even a single dose of naltrexone in the ED can jump-start treatment and is generally safe and well-tolerated. However, MAUD has rarely been offered in the ED, but the growing evidence suggests it increases treatment engagement and reduces drinking. Many of these medications have been thoroughly investigated, are safe to administer, and are effective at reducing alcohol consumption. Furthermore. In 2024, the Society for Academic Emergency Medicine (SAEM) published Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4) on alcohol use disorder and recommend prescribing MAUD.
Many patients with alcohol use disorder face numerous societal obstacles and are less likely to access follow-up care. Therefore, initiating MAUD in the emergency department might be the only opportunity to start treatment.
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