Written by Elizabeth Cairns, Mobilize Recovery Special Projects and Michael Masiowski, MD, reviewed by Code Recover Clinician Advisors, August 2026

Dr. Arianna Campbell talks about measuring success in ED programs for OUD

Dr. Phillip Moschella talks about success measures for peer programs in the ED.

The liability exposure for not offering MOUD to patients with OUD is growing substantially, driven by the convergence of evolving standard of care definitions, new accreditation requirements, state legislative mandates, and the well-documented mortality risk of untreated OUD. The legal framework for such claims is increasingly well established: a Legal Action Center analysis found that hospitals denying evidence-based SUD care may be violating four separate federal laws — EMTALA, the Americans with Disabilities Act, the Rehabilitation Act, and Title VI — and that failing to offer buprenorphine to a patient with OUD could constitute a failure to stabilize under EMTALA. (source)

An apt comparison would be to the recent change from fear of administering thrombolytics for stroke because of the risk of ICH, to vastly increased liability risk if thrombolytics are not offered. This is not speculative. In a review of closed malpractice cases involving tPA and acute ischemic stroke, every claim identified stemmed from failure to give tPA or delay in giving it — only one case involved hemorrhage after administration, and that suit was brought over the delay. The authors concluded that the medicolegal risk of withholding tPA is clear, while they found no clear risk in providing it when indicated. (source)

MOUD is now the standard of care for patients who present with OUD. (source) The CDC states that clinicians who identify OUD should offer or arrange evidence-based treatment with medications, and should not dismiss patients from practice because of their OUD. (source) A 2026 expert consensus panel rated hospital-based buprenorphine and methadone initiation as "appropriate," with a median appropriateness score of 9 out of 9. (source)

Accreditation requirements

The Joint Commission's Standard CTS.04.02.33 requires organizations providing addiction care to implement the following measures: (source)

• Offering MOUD as part of a treatment plan
• Coordinating referrals
• Confirming medication initiation
• Educating patients about the dangers of abrupt discontinuation
• Documenting if a patient declines MOUD

Peer navigation as risk mitigation

A peer navigation program can be a powerful risk mitigation tool. Peer programs provide a structured process for helping to meet the following risk mitigation elements:

• Offering MOUD
• Documenting the offer and the patient's response
• Providing naloxone and overdose prevention education
• Establishing warm handoff protocols
• Educating patients about risks of treatment discontinuation

While the Joint Commission does not mandate peer navigation programs, they represent one of the most practical mechanisms for meeting all of the requirements. California's CA Bridge program, which pairs ED-initiated buprenorphine with patient navigation, has been implemented in more than 80% of the state's emergency departments and recorded over 165,000 navigator encounters and nearly 45,000 instances of buprenorphine treatment across an eighteen-month period. (source) Peer support has also been associated with improved engagement and retention across the OUD treatment cascade (source) and with reduced hospital utilization following ED-based peer intervention. (source)