Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention

D’Onofrio, Gail; Chawarski, Marek C.; O’Connor, Patrick G.; Pantalon, Michael V.; Busch, Susan H.; Owens, Pamela L; Hawk, Kathryn; Bernstein, Steven L.; Fiellin, David A.

doi:10.1007/s11606-017-3993-2

Cited by 208 publications

(153 citation statements)

References 20 publications

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“…11,12 A multidisciplinary and multidimentional approach not only for HCV care but also for opioid substitution therapy might significantly improve linkage-to-care rate. 11,13 Regarding limitations, this is a single institution study with a small number of seroconversions. In addition, our estimates of incidence are based only on tests within our health system.…”

Section: Discussionmentioning

confidence: 98%

“…Successfully linking newly diagnosed (including incident) HCV‐infected ED patients for HCV care at specialty clinic has been widely recognized as one of the most critical steps for eliminating HCV in the community; challenges remain, however, as linkage rate from other ED are in the low 30s . A multidisciplinary and multidimentional approach not only for HCV care but also for opioid substitution therapy might significantly improve linkage‐to‐care rate …”

Section: Discussionmentioning

confidence: 99%

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Emergency departments at the crossroads of intersecting epidemics (HIV, HCV, injection drug use and opioid overdose)—Estimating HCV incidence in an urban emergency department population

Hsieh

Patel

Loevinsohn

et al. 2018

Journal of Viral Hepatitis

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High seroprevalence of HCV antibody (anti-HCV) is common among urban emergency department (ED) patients. Little is known regarding incidence of HCV infection in ED patients. We conducted a longitudinal chart-review (2003-2016) of a subset of ED patients between December 2015 and January 2016 (the ‘index period’) in an urban ED that began an ED-based HCV screening program since November 2015. Patients were eligible for inclusion if they presented to the ED during the ‘index period’ and had at least one negative anti-HCV test between 2003 and 2015, and at least one test after the ‘index visit’. Follow-up time (person-years) was calculated for each patient. Incidence ratio (IR) and corresponding 95% CI was used to present the relative incidence between groups. 2% (6/299) patients included had HCV seroconversion during 1706.0 person-years, resulting in an HCV incidence of 3.5/1,000 person-years (95% CI: 1.4, 7.3). Incidence was significantly higher in white patients (IR: 12.9), people who inject drugs (IR: 17.4), and patients with unknown/unaware HIV status (IR: 8.3). The relatively high HCV incidence in urban ED patients, especially in subgroups disproportionately impacted by opioid use and/or HIV, indicate that EDs represent a critical venue for detecting HCV and should consider prevention services against these intersecting epidemics.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Emergency departments at the crossroads of intersecting epidemics (HIV, HCV, injection drug use and opioid overdose)—Estimating HCV incidence in an urban emergency department population

Hsieh

Patel

Loevinsohn

et al. 2018

Journal of Viral Hepatitis

View full text Add to dashboard Cite

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“…Recent evidence suggests that ED-initiated buprenorphine increases subsequent engagement in addiction treatment and reduces illicit opioid use. 27 Devoting more health resources to initiating evidence-based ED-based treatments for patients with opioid use disorder in health systems, including ED-initiated buprenorphine and referral to SUD treatment, 27 may be a step toward improving health outcomes and reducing high SUD-related ED visits among patients with opioid use disorder.…”

Section: Discussionmentioning

confidence: 99%

Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters

et al. 2018

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Background Changes in substance use patterns stemming from opioid misuse, ongoing drinking problems, and marijuana legalization may result in new populations of patients with substance use disorders (SUDs) using emergency department (ED) resources. This study examined ED admission trends in a large sample of patients with alcohol, marijuana, and opioid use disorders in an integrated health system. Methods In a retrospective design, electronic health record (EHR) data identified patients with ≥1 of 3 common SUDs in 2010 (n = 17,574; alcohol, marijuana, or opioid use disorder) and patients without SUD (n = 17,574). Logistic regressions determined odds of ED use between patients with SUD versus controls (2010–2014); mixed-effect models examined 5-year differences in utilization; moderator models identified subsamples for which patients with SUD may have a greater impact on ED resources. Results Odds of ED use were higher at each time point (2010–2014) for patients with alcohol (odds ratio [OR] range: 5.31–2.13, Ps < .001), marijuana (OR range: 5.45–1.97, Ps < .001), and opioid (OR range: 7.63–4.19, Ps < .001) use disorders compared with controls; odds decreased over time (Ps < .001). Patients with opioid use disorder were at risk of high ED utilization; patients were 7.63 times more likely to have an ED visit in 2010 compared with controls and remained 5.00 (average) times more likely to use ED services. ED use increased at greater rates for patients with alcohol and opioid use disorders with medical comorbidities relative to controls (Ps < .045). Conclusions ED use is frequent in patients with SUDs who have access to private insurance coverage and integrated medical services. ED settings provide important opportunities in health systems to identify patients with SUDs, particularly patients with opioid use disorder, to initiate treatment and facilitate ongoing care, which may be effective for reducing excess medical emergencies and ED encounters.

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“…From an economic perspective, Horn et al (2016) found case management to be economically effective in a cohort of high-cost medically complex patients in New Mexico. Additionally, ED-initiated buprenorphine treatment has been found to significantly increase engagement in addiction treatment and reduce illicit opioid use (D’Onofrio et al, 2017; D’Onofrio et al, 2015). Also, it may be the case that more intensive interventions may be required to benefit individuals with serious drug use disorders.…”

Section: Discussionmentioning

confidence: 99%

Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments

Horn

Crandall

Forcehimes

et al. 2017

Journal of Substance Abuse Treatment

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Screening, brief intervention, and referral to treatment (SBIRT) has been widely implemented as a method to address substance use disorders in general medical settings, and some evidence suggests that its use is associated with decreased societal costs. In this paper, we investigated the economic impact of SBIRT using data from Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED), a multisite, randomized controlled trial. Utilizing self-reported information on medical status, health services utilization, employment, and crime, we conduct a benefit-cost analysis. Findings indicate that neither of the SMART-ED interventions resulted in any significant changes to the main economic outcomes, nor had any significant impact on total economic benefit. Thus, while SBIRT interventions for substance abuse in Emergency Departments may be appealing from a clinical perspective, evidence from this economic study suggests resources could be better utilized supporting other health interventions.

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Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention

Abstract: ED-initiated buprenorphine was associated with increased engagement in addiction treatment and reduced illicit opioid use during the 2-month interval when buprenorphine was continued in primary care. Outcomes at 6 and 12 months were comparable across all groups.

Cited by 208 publications

References 20 publications

Emergency departments at the crossroads of intersecting epidemics (HIV, HCV, injection drug use and opioid overdose)—Estimating HCV incidence in an urban emergency department population

Emergency departments at the crossroads of intersecting epidemics (HIV, HCV, injection drug use and opioid overdose)—Estimating HCV incidence in an urban emergency department population

Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters

Benefit-cost analysis of SBIRT interventions for substance using patients in emergency departments

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