IMPORTANCE Treatment of opioid use disorder (OUD) with buprenorphine decreases opioid use and prevents morbidity and mortality. Emergency departments (EDs) are an important setting for buprenorphine initiation for patients with untreated OUD; however, readiness varies among ED clinicians. OBJECTIVE To characterize barriers and facilitators of readiness to initiate buprenorphine for the treatment of OUD in the ED and identify opportunities to promote readiness across multiple clinician types.

Objective Opioid abuse and overdose constitute an ongoing health emergency. Many presume opioids have little potential for iatrogenic addiction when used as directed, particularly in short courses as is typical of the ED setting. We preliminarily explored the possibility that initial exposure to opioids by EDs could be related to subsequent opioid misuse. Methods This cross-sectional study surveyed a convenience sample of patients reporting heroin or non-medical opioid use at an urban, academic ED. We estimated the proportion whose initial exposure to opioids was a legitimate medical prescription and the proportion of those prescriptions that came from an ED. Secondary measurements included 1) the proportion using non-opioid substances before initial opioid exposure, 2) the source of opioids between initial exposure and onset of regular non-medical use, and 3) time from initial prescription to opioid use disorder. Results Of 59 subjects, 35 (59%; 95%CI: 47-71) reported they were first exposed to opioids by a legitimate medical prescription, and for 10/35 (29%; 95%CI: 16-45), the prescription came from an ED. Most medically exposed subjects (28/35, 80%; 95%CI: 65-91) reported non-opioid substance use or treatment for non-opioid substance use disorders preceding the initial opioid exposure. Emergency providers were a source of opioids between exposure and onset of regular non-medical use in 11/35 (31%, 95%CI: 18-48) cases. Thirty-one of the 35 medically exposed subjects reported the time of onset of non-medical use; median time from exposure to onset of non-medical use was: 6 months for use to get high (N=25; IQR 2-36), 12 months for regular use to get high (N=24, IQR: 2-36), 18 months for use to avoid withdrawal (N=26, IQR: 2-38), and 24 months for regular use to avoid withdrawal (N=27, IQR: 2-48). Eleven (36%, 95%CI: 21-53) began non-medical use within 2 months, and 9/11 (82%, 95%CI: 53-96) reported non-opioid substance use or treatment for alcohol abuse prior to initial opioid exposure. Conclusion Although short-term opioid administration by emergency providers is unlikely to cause addiction by itself, ED opioid prescriptions may contribute to the development of addiction in some patients. There is an urgent need for further research to estimate long-term risks of short-course opioid therapy, so that the risk of iatrogenic addiction can be appropriately balanced with the benefit of analgesia.

IMPORTANCE Medical treatment settings such as emergency departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization.OBJECTIVE To contrast the effects of a brief intervention with telephone boosters (BI-B) with those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients.

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Targeted screening remains an important approach to human immunodeficiency virus (HIV) testing. The authors aimed to derive and validate an instrument to accurately identify patients at risk for HIV infection, using patient data from a metropolitan sexually transmitted disease clinic in Denver, Colorado (1996-2008). With multivariable logistic regression, they developed a risk score from 48 candidate variables using newly identified HIV infection as the outcome. Validation was performed using an independent population from an urban emergency department in Cincinnati, Ohio. The derivation sample included 92,635 patients; 504 (0.54%) were diagnosed with HIV infection. The validation sample included 22,983 patients; 168 (0.73%) were diagnosed with HIV infection. The final score included age, gender, race/ethnicity, sex with a male, vaginal intercourse, receptive anal intercourse, injection drug use, and past HIV testing, and values ranged from -14 to +81. For persons with scores of <20, 20-29, 30-39, 40-49, and ≥50, HIV prevalences were 0.31% (95% confidence interval (CI): 0.20, 0.45) (n = 27/8,782), 0.41% (95% CI: 0.29, 0.57) (n = 36/8,677), 0.99% (95% CI: 0.63, 1.47) (n = 24/2,431), 1.59% (95% CI: 1.02, 2.36) (n = 24/1,505), and 3.59% (95% CI: 2.73, 4.63) (n = 57/1,588), respectively. The risk score accurately categorizes patients into groups with increasing probabilities of HIV infection.