Despite ‘proven efficacy,’ buprenorphine scripts remain low after opioid-related events

Key takeaways:

• Buprenorphine was prescribed in only 5.7% of opioid-related ED encounters occurring between 2020 to 2022.
• The findings may be due to factors like practitioner hesitancy, stigma and a lack of follow-up.

Buprenorphine use increased in EDs over the last decade but remained underused after opioid-related encounters, a cross-sectional study published in JAMA Network Open suggested.

Results from the analysis show racial and gender disparities influencing the odds of treatment with buprenorphine, according to study investigators.

Past research has shown buprenorphine for opioid use disorder in EDs is safe, effective and can have a positive impact on maintaining treatment engagement.

“Increasing the availability of buprenorphine is an important component of the public health response to the opioid epidemic,” Neeraj Chhabra, MD, MSCR, an assistant professor at the University of Chicago, Illinois, and colleagues wrote. “As a low-barrier point of contact, EDs represent a critical setting for buprenorphine initiation, although practices are varied, with local disparities in buprenorphine initiation.”

The researchers, aiming to determine initiation and disparities at a national level, examined ED buprenorphine administration and prescribing data that spanned from Jan. 1, 2013, to Dec. 31, 2022.

Among 1,632,674 opioid-related encounters during the study period, 217,832 involved initiation of buprenorphine.

Emergency encounters involving buprenorphine rose from 2.75% of opioid-related encounters in 2013 to 27.3% in 2022, with increases in both administration and prescribing.

However, of 745,289 opioid-related encounters involving 452,684 unique patients in the most recent 3 years, only 14.8% had buprenorphine administered and 5.7% received a prescription.

The researchers highlighted possible negative effects that could arise from the lack of buprenorphine prescribing.

“One-time administration without maintenance prescription may negatively impact treatment retention, as withdrawal symptoms are likely to be delayed with one-time dosing,” they wrote. “A 7-day extended-release injectable formulation can be considered when barriers to prescribing exist.”

Results showed men had higher odds for receiving buprenorphine (OR = 1.17; 95% CI, 1.15-1.18).

Chhabra and colleagues also noted that white participants had increased odds of receiving buprenorphine when compared with American Indian or Alaska Native participants (OR = 0.91; 95% CI, 0.87-0.94), Asian participants (OR = 0.83; 95% CI, 0.77-0.9), Black participants (OR = 0.71; 95% CI, 0.7-0.72), Native Hawaiian or other Pacific Islander participants (OR = 0.72; 95% CI, 0.64-0.82) and participants of other races (OR = 0.86; 95% CI, 0.83-0.9).

The analysis had some limitations acknowledged by Chhabra and colleagues, which included a lack of availability for certain variables and its retrospective design.

Broad implementation of buprenorphine in EDs is affected by several factors, including “lack of local follow-up, practitioner hesitancy, stigma surrounding substance use treatment and insufficient resources for addressing co-occurring social determinants of health,” the researchers wrote.

“Addressing barriers and reducing disparities in buprenorphine use in EDs is imperative to harness its proven efficacy in decreasing opioid use and preventing premature death,” they added.

Chhabra and colleagues concluded that further research is needed to better understand and address the factors contributing to the observed disparities, “thereby enhancing the ED’s capacity as an intervention point in the opioid epidemic.”