Patients given buprenorphine in ED have better chances of staying on OUD treatment

Key takeaways:

• Buprenorphine treatment in the ED was associated with almost two times greater odds of 30-day OUD treatment.
• The findings show how EDs can be a “critical access point” for OUD treatment, researchers said.

Patients with opioid use disorder, or OUD, who were treated with buprenorphine during an ED visit had greater odds of continued treatment engagement 30 days later, a study in JAMA Network Open showed.

“There is an urgent need to roll out large-scale interventions to reduce opioid-related overdose deaths,” Andrew A. Herring, MD, an assistant clinical professor at the University of California, San Francisco, and colleagues wrote. “A substantial effect of ED buprenorphine access on subsequent OUD treatment engagement could potentially help set benchmarks for buprenorphine delivery to ED patients with OUD, enhance clinical decision-making, and guide policy efforts aimed at optimizing the ED’s role in addressing the opioid crisis.”

The researchers evaluated the associations between ED buprenorphine treatment and subsequent OUD treatment 1 month later in a multicohort study that included 464 ED patients (mean age, 36 years; 73.9% men). The study took place at seven California EDs that were participating in a statewide program to improve access to the drug.

All patients were offered buprenorphine, among whom 85.8% accepted. Of the patients who accepted, 58% were administered buprenorphine in the ED and 73.1% were given a prescription.

Approximately half of patients (49.7%) who received buprenorphine in the ED remained engaged in treatment at 1 month compared with 22.7% who did not receive it in the ED. Buprenorphine treatment in the ED was associated with almost two times greater odds of 30-day OUD treatment (adjusted RR = 1.97; 95% CI, 1.27-3.07).
engaged in OUD treatment at the 30-day mark, 51.6% had been both prescribed and administered buprenorphine during their ED visit, compared with 39.8% of patients who were not engaged in OUD treatment.

Herring and colleagues noted that the findings underscore “the critical access point to OUD treatment that EDs can provide” and are notable given the prevalence of self-reported use of fentanyl (52.2%), methamphetamine (50%) and comorbid mental health conditions (71.5%) in the cohort.

However, “the low OUD treatment engagement at 30 days among those not treated with buprenorphine emphasizes the need for additional interventions to reach this population,” they wrote.

Herring and colleagues pointed out there were some limitations in the study, such as potential selection bias toward patients with interest in the treatment due to the high rate of buprenorphine acceptance.

“Future research should investigate techniques to optimize both the uptake and effectiveness of buprenorphine initiation in low-threshold settings such as the ED,” they concluded.