Copyright © 2018 American Society of Addiction Medicine. Unauthorized reproduction of this article is prohibited. An Exploration of Emergency Physicians’ Attitudes Toward Patients With Substance Use Disorder Cecelia Kathleen Mendiola, BA, Giorgio Galetto, MD, and Michael Fingerhood, MD Objectives: Much is known about some healthcare professionals’ attitudes toward patients with substance use disorders, but few studies have specifically looked at emergency department (ED) physicians. Individuals with substance use disorders are more likely to be people who chronically, frequently use the ED, and thus ED physicians are in a unique position to provide early identification and intervention for people struggling with addiction. The purpose of this study was to understand ED physicians’ attitudes toward patients with substance use disorder with the aim of decreasing stigma and improving the care of ED patients with substance use disorder. Methods: An anonymous Qualtrics survey was emailed to 115 emergency physicians in the Johns Hopkins Health System. The survey contained (1) demographics and (2) the medical condition regard scale, http://links.lww.com/JAM/A67. Participants were offered a $10 Amazon gift card to complete the survey. Results: The response rate was 50% (n ¼ 58) and the completion rate was 43% (n ¼ 50). Physicians had lower regard for patients with substance use disorders than other medical conditions with behav- ioral components. Of note, 54% of respondents indicated that they at least ‘‘somewhat agree’’ that they ‘‘prefer not towork with patients with substance use who have pain.’’ Conclusions: A significant portion of our study population had low regard for patients with substance use. Future research is needed to determine significant contributing factors and develop interventions to mitigate negative attitudes among ED physicians toward patients with substance use disorder. Key Words: attitudes, emergency department, stigma, substance use disorder (J Addict Med 2018;12: 132–135) S ubstance use disorder (SUD) is a major health problem in the United States. In 2015, an estimated 7.8% of people age 12 or older had either illicit drug or alcohol use disorder or both in the United States (Center for Behavioral Health Statistics and Quality, 2016). Additionally, the United States is currently facing a major opioid epidemic with provisional data from 2016 estimating 64,068 deaths due to all drug overdose in 2016: nearly 20,000 involving fentanyl or other synthetic opioids, over 14,000 involving prescription opioids, and over 15,000 involving heroin (Ahmad et al., 2017). However, research has shown that many healthcare providers have negative attitudes toward patients struggling with drugs and alcohol. A European multicenter study of 866 health professionals in different specialties showed that regard for working with people who use drugs and alcohol was lower than for other patient groups, such as patients with diabetes or depression (Gilchrist et al., 2011). Similarly, focus groups and interviews conducted with 35 health and social care profes- sionals in Northern Ireland found that most professionals in the study had difficulty sympathizing with people who used illicit drugs (McLaughlin et al., 2006). A study in Australia demonstrated that of 1605 nurses surveyed, only 30% were motivated to work with patients with drug-related problems (Ford et al., 2008). However, not all medical specialties view patients with SUD in the same way. Unsurprisingly, research from the Netherlands found that addiction specialists had higher regard for patients with substance use problems than either general practitioners or those working in general psychiatry (van Boekel et al., 2014). While many studies have looked at primary care profes- sionals’ attitudes toward patients with substance use disorders, few studies have looked specifically at emergency department (ED) physicians (van Boekel et al., 2013). In 2013, there were 2519 ED visits per 100,000 population involving substance use disorders in the United States, a 37% increase from 2006 (Healthcare Cost and Utilization Project [HCUP], 2016). People with substance use disorders are more likely to chronically and frequently use the ED (Mandelberg et al., 2000; Billings and Raven, 2013). Furthermore, with the current opioid epidemic, many overdoses are treated in the ED. Thus, ED physicians are in a unique position to identify and provide early intervention for people struggling with addiction. Furthermore, stigma can have From the Deparment of Medicine (CKM, MF); Department of Emergency Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD (GG). Received for publication August 1, 2017; accepted December 13, 2017. This work was funded by the Johns Hopkins School of Medicine Dean’s Funding, the Johns Hopkins School of Medicine Department of Psychiatry William Walker Award, and the American Medical Women’s Association (AMWA) Dr. Elizabeth Small Grant. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.journaladdictionmedicine.com). Send correspondence to Michael Fingerhood, MD, Associate Professor of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Mason Lord Building, West Tower, 5th Floor, Baltimore, MD 21224. E-mail: mfinger3@jhmi.edu; Cecelia Kathleen Mendiola, BA, Johns Hopkins School of Medicine, Baltimore, Maryland. E-mail: cmendiola@jhmi.edu Copyright ß 2018 American Society of Addiction Medicine ISSN: 1932-0620/18/1202-0132 DOI: 10.1097/ADM.0000000000000377 132 J Addict Med  Volume 12, Number 2, March/April 2018 ORIGINAL RESEARCH