Delaware Hospitals Adopt Statewide Emergency Department Guidance for Opioid Use Disorder Treatment

Delaware has become the first state in the nation to implement uniform, evidence-based protocols for treating opioid use disorder in hospital emergency departments. The new statewide guidance, announced July 7, 2026, establishes consistent standards for how emergency departments identify, treat, and connect patients experiencing opioid withdrawal or overdose to ongoing care.

The initiative represents nearly a year of collaboration among emergency physicians, addiction specialists, hospital systems, behavioral health professionals, and state health officials. For families navigating the crisis of a loved one's opioid use, the new protocols promise more reliable access to life-saving treatment at what experts describe as the single most critical intervention point.

A State with One of the Nation's Highest Overdose Rates

Delaware faces a severe opioid crisis. The state consistently ranks among the top three in the nation for opioid overdose deaths, with emergency departments encountering an average of 2,062 suspected opioid overdoses annually since 2021, according to state health department data.

"Every emergency department encounter represents an opportunity to save a life and begin the path to recovery," said Joanna Champney, Director of the Delaware Division of Substance Abuse and Mental Health, at the announcement event. "By adopting a common set of evidence-based practices statewide, Delaware's hospitals are ensuring that patients receive consistent, compassionate care and stronger connections to treatment, regardless of where they seek help."

The guidance was developed through Delaware's Overdose System of Care (OSOC), established by state legislation in 2018 to coordinate treatment among hospitals, emergency medical services, community treatment providers, and state agencies.

What the New Guidance Requires

The 54-page guidance document addresses every stage of the emergency department experience, from initial patient screening to discharge planning and warm handoffs to community providers. Five priority areas form the framework:

Screening and Identification: Emergency departments are encouraged to implement brief, validated screening tools integrated into triage or electronic health record workflows. The guidance emphasizes staff education and stigma-reduction training to ensure patients with opioid use disorder are identified consistently, not just when they present after an overdose or in obvious withdrawal.

Patient Engagement: The protocols recommend trauma-informed, patient-centered communication and expanded access to Certified Peer Recovery Specialists and Care Navigators. These specialists provide 24/7 support to help patients understand their options and connect with treatment.

Medication Initiation: Perhaps most significantly, the guidance establishes flexible protocols for starting buprenorphine-naloxone in the emergency department. This includes high-dose "macro-induction" approaches and home-start options, with built-in electronic health record order sets to streamline the process. Research consistently shows that initiating medication for opioid use disorder in the emergency department significantly increases the likelihood that patients will remain in treatment.

Transitions of Care: The guidance mandates use of the Delaware Treatment Referral Network for seamless referrals to community providers. Care navigators coordinate follow-up appointments before patients are discharged, addressing one of the most common gaps in addiction treatment—the dangerous period between emergency care and ongoing treatment.

Documentation and Billing: The protocols include specific diagnosis and billing codes to ensure accurate tracking, reimbursement, and program sustainability.

Why Emergency Departments Matter

Emergency departments have increasingly become the front line of the opioid crisis. For many individuals with opioid use disorder, an ED visit—whether for overdose, withdrawal, or related complications—represents their only contact with the healthcare system.

"The emergency department may be the single most important opportunity to intervene after an overdose or during opioid withdrawal," said Dr. Robert Rosenbaum, State EMS and Preparedness Section Medical Director for the Delaware Division of Public Health. "This guidance brings together the best practices developed by emergency physicians and clinical partners across Delaware so patients have the greatest possible chance to begin treatment, remain engaged in care, and ultimately achieve recovery."

The Delaware approach aligns with national recommendations from the American College of Emergency Physicians and builds on growing evidence that emergency departments can effectively initiate addiction treatment. Studies show that patients who receive buprenorphine in the emergency department are twice as likely to be engaged in treatment one month later compared to those who receive only referrals.

Addressing Stigma and Inconsistent Care

Before the new guidance, approaches to opioid use disorder in Delaware emergency departments varied widely. Some hospitals relied on ad hoc screening, while others used universal screening tools. Not all EDs had pathways to initiate medication, and referral processes were often fragmented.

Working groups identified stigma as a persistent barrier. Some clinicians expressed discomfort initiating conversations about substance use, and concerns about limited community resources sometimes discouraged screening altogether.

The new guidance explicitly addresses these challenges by establishing OUD as a chronic medical condition to be treated with the same urgency and systematic approach as stroke or trauma. It emphasizes person-centered language and reducing judgment in patient interactions.

What This Means for Families

For families of individuals struggling with opioid use, the statewide protocols offer several important protections:

Consistent standards: Regardless of which hospital a patient visits, the approach to screening, treatment, and referral will follow the same evidence-based framework.

Medication access: Emergency departments are now expected to offer buprenorphine initiation when clinically appropriate, giving patients immediate relief from withdrawal and a bridge to ongoing care.

Warm handoffs: Rather than simply providing a phone number for treatment, hospitals are expected to coordinate directly with community providers and peer specialists to ensure patients have appointments and support in place before discharge.

24/7 support: The guidance expands access to peer recovery specialists who can meet with patients in the emergency department at any hour.

Looking Forward

Unlike trauma or stroke systems of care, which have regulatory compliance requirements, Delaware's opioid use disorder guidance relies on voluntary adoption by health systems. However, state officials expect broad implementation given the collaborative development process and the clear evidence supporting emergency department-initiated treatment.

The OSOC Data & Quality Subcommittee will monitor implementation using four "North Star" measures: medications for opioid use disorder prescribed at ED discharge, outpatient engagement in follow-up treatment, medication initiation after ED discharge, and sustained engagement in treatment.

Delaware's approach could serve as a model for other states grappling with similar challenges. By standardizing care across all hospital systems, the state aims to reduce overdose deaths, improve care quality, and strengthen coordination between emergency departments, community providers, and state systems.

For Delaware families affected by opioid use disorder, the new guidance represents a significant step toward treating addiction with the urgency, consistency, and compassion that the crisis demands.

If you or someone you know is struggling with opioid use in Delaware, help is available 24/7:

Delaware Hope Line: 1-833-9-HOPEDE (1-833-946-7333)
SAMHSA National Helpline: 1-800-662-4357
Crisis Text Line: Text HOME to 741741