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Addressing the opioid crisis in the era of competency-based medical education: recommendations for emergency department interventions.

In Canada, opioid-related deaths continue to rise at an alarming rate. In 2017, there were 3,996 apparent opioid-related deaths (33% increase from 2016), significantly greater in magnitude as compared with deaths caused by previous public health crises, e.g., H1N1 in 2009 (428 deaths). Opioid-related emergency department (ED) visits have also increased. From 2012 to 2017, the age-adjusted rate of ED visits because of opioid poisoning increased by 136% in Alberta (from 37.6 to 88.6 per 100,000 population) and 47% in Ontario (from 23.5 to 34.6 per 100,000 population). Because of stigma and social instability, the ED is often the main source of healthcare for patients with substance use disorders. An ED visit may be the only, or last, point of contact with the health care system prior to an individual experiencing a fatal overdose. Patients with opioid use disorders have a life-threateningmedical condition, and emergency medicine (EM) physicians and residents play a critical role in preventing future morbidity and mortality. The transition to competency-based medical education offers opportunities for residents to apply public health interventions within the scope of EM training, identify patients with opioid use disorders effectively, reduce harms associated with opioid use, initiate treatment, and refer patients for ongoing management. In this paper, we highlight relevant entrustable professional activities and key interventions that should be targeted for learning by residents and faculty on shift. OPIOID USE DISORDER AND COMPETENCE BY DESIGN