Abstract
Background
Buprenorphine is an effective treatment for opioid use disorders. A previous randomized
trial comparing emergency department (ED)-initiated buprenorphine to standard care
showed dramatic improvement in follow-up. This is encouraging, but must be replicated
to understand the generalizability of buprenorphine treatment.
Objectives
Evaluate the efficacy of an ED-initiated buprenorphine protocol similar to a previous
randomized trial in a different population.
Methods
This ED-based descriptive study described the results of a project implementing an
opioid use disorder treatment protocol that included buprenorphine. Patients with
opioid use disorder were offered treatment with buprenorphine, a buprenorphine prescription
whenever possible, and a follow-up visit to a clinic providing addiction treatment.
The primary outcome was engagement in formal addiction treatment 30 days after the
index visit.
Results
Of the 210 patients who accepted referral for outpatient medication-assisted treatment,
95 (45.2%) achieved the primary outcome. Two-thirds of these patients received a buprenorphine
prescription at discharge; 40% were homeless. A regression analysis revealed one statistically
significant predictor of the primary outcome: patients who were housed were 2.49 times
more likely to engage in opioid use disorder treatment than patients who were homeless
(p = 0.02).
Conclusions
In this descriptive study of an ED-initiated buprenorphine protocol, follow-up was
less than that reported in a previous randomized controlled trial. Two important differences
between our study and the randomized trial are the high rate of homelessness and the
fact that not every patient received a prescription for buprenorphine. The efficacy
of ED-initiated treatment may depend on certain population characteristics.
Keywords
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Article info
Publication history
Published online: December 18, 2022
Accepted:
December 12,
2022
Received in revised form:
November 20,
2022
Received:
August 6,
2022
Publication stage
In Press Uncorrected ProofFootnotes
Meetings: Preliminary results were reported at the 2022 American College of Emergency Physicians meeting in New Orleans.
Identification
Copyright
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