Aim: The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN), an entity aimed at bridging researchers and community-based substance abuse treatment providers to develop new treatment approaches, has taken an interest in the dissemination of findings from a randomized clinical trial by D’Onoffio demonstrating that initiating buprenorphine in the emergency department (ED) enhances linkage to treatment [ JAMA 2015; 313 (16): 1636–1644]. In the Southern Consortium Node of the CTN, the authors have taken an implementation science approach to expand on the D’Onofrio study by implementing an ED-based buprenorphine initiation program in three diverse South Carolina EDs utilizing a predominantly peer recovery coach model. The aim of this pilot program was to foundationally integrate universal screening, brief interventions and referral to treatment (SBIRT) in hospital EDs to identify patients with at-risk substance use. Through brief interventions, patient navigators assessed readiness to change and motivation for treatment of patients. Patients willing to engage in treatment were referred to appropriate community resources. Patients identified to have opioid use disorder (OUD) and willing to engage in treatment were eligible for ED-initiated buprenorphine and peer recovery coaches assisted in arranging next day follow up with a community treatment program or other local provider for ongoing treatment. Method: Hospital partner sites included a large academic medical center, a large private hospital, and a small community hospital. Prior to implementing this quality improvement initiative, the authors completed an ED workflow analysis at each site, developed internal planning committees including identification of a “hospital champion,” facilitated electronic health record modifications, educated more than 200 ED nurses and providers, and identified a network of local community “fast-track” providers able to accept patients for next-day appointments. Results: Within 14 months, all three sites were fully operationalized and project staff in 3 ED sites screened 6523 patients for substance misuse with 33.0% screened positive for at-risk substance use. Positive screening results were as follows by substance: 907 alcohol, 100 cocaine, 40 methamphetamine, 7 amphetamines, 96 marijuana, 12 benzodiazepines, 3 Ecstasy/MDMA/Molly, 10 other/unknown substance, 274 heroin, 90 prescription opioids, 32 other/unknown opioid, 254 undetermined polysubstance use without opioids, and 331 polysubstance use with opioids. Of the 727 positive screened patients for non-medical opioid use, 70.0% were determined potentially eligible to receive buprenorphine initiation. Two-hundred thirty-one patients were initiated with one dose of 8 mg sublingual buprenorphine or 8-2 mg sublingual buprenorphine/naloxone; 76.6% of those initiated arrived to next-day appointments for continued medications for opioid use disorder (MOUD); and 59.9% o...

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Introduction: Opioid addiction and misuse constitute a public health crisis in the United States. Recent research supports buprenorphine induction in the emergency department (ED) setting for patients with opioid use disorder (OUD). However, education regarding buprenorphine induction for emergency medicine (EM) physicians, residents, and students is still limited. Methods: We created a 1-hour introductory workshop for the identification and treatment of opioid withdrawal and OUD in the ED for medical students going into EM and for EM interns. The workshop consisted to two distinct curricular sections: (1) a didactic session providing an overview of the basic knowledge and skills to identify and treat patients with OUD in the ED and (2) a case-based session in which students worked through the identification of opioid withdrawal; discussion of opioid use with the patient, going through the steps of SBIRT (screening, brief intervention, and referral to treatment); and considerations when starting buprenorphine. The workshop was evaluated using a pre-and posttest examining medical knowledge around buprenorphine use in the ED. Results: A total of 48 students and interns participated in the curriculum. The students showed a significant improvement in medical knowledge between the pre-and posttests, with an average 45% higher score on the posttest (p < .001). Discussion: Our workshop resulted in a short-term improvement in medical students' and interns' knowledge of the identification and treatment of patients with OUD in the ED.