Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study

Le, Tinh; Cordial, Parker; Sankoe, Mackenzie; Purnode, Charlotte; Parekh, Ankur; Baker, Thomas P.; Hiestand, Brian; Peacock, W. Frank; Neuenschwander, James

doi:10.5811/westjem.2021.6.51306

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Estimated program effects were also likely determined by unmeasured interventions to address OUD that were implemented in treatment or comparison group sites. For example, ED buprenorphine prescribing has been shown to be associated with increased postdischarge treatment engagement, 50 , 51 , 52 and MOUDs have been associated with lower risk of overdose. 8 , 53 , 54 In a study demonstrating that patients who received an ED-based intervention from a substance use navigator had greater treatment initiation, treatment initiation was increased further with ED-administered medication.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose

Treitler,

Crystal,

Cantor

et al. 2024

JAMA Netw Open

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ImportancePatients treated in emergency departments (EDs) for opioid overdose often need drug treatment yet are rarely linked to services after discharge. Emergency department–based peer support is a promising approach for promoting treatment linkage, but evidence of its effectiveness is lacking.ObjectiveTo examine the association of the Opioid Overdose Recovery Program (OORP), an ED peer recovery support service, with postdischarge addiction treatment initiation, repeat overdose, and acute care utilization.Design, Setting, and ParticipantsThis intention-to-treat retrospective cohort study used 2014 to 2020 New Jersey Medicaid data for Medicaid enrollees aged 18 to 64 years who were treated for nonfatal opioid overdose from January 2015 to June 2020 at 70 New Jersey acute care hospitals. Data were analyzed from August 2022 to November 2023.ExposureHospital OORP implementation.Main Outcomes and MeasuresThe primary outcome was medication for opioid use disorder (MOUD) initiation within 60 days of discharge. Secondary outcomes included psychosocial treatment initiation, medically treated drug overdoses, and all-cause acute care visits after discharge. An event study design was used to compare 180-day outcomes between patients treated in OORP hospitals and those treated in non-OORP hospitals. Analyses adjusted for patient demographics, comorbidities, and prior service use and for community-level sociodemographics and drug treatment access.ResultsA total of 12 046 individuals were included in the study (62.0% male). Preimplementation outcome trends were similar for patients treated in OORP and non-OORP hospitals. Implementation of the OORP was associated with an increase of 0.034 (95% CI, 0.004-0.064) in the probability of 60-day MOUD initiation in the half-year after implementation, representing a 45% increase above the preimplementation mean probability of 0.075 (95% CI, 0.066-0.084). Program implementation was associated with fewer repeat medically treated overdoses 4 half-years (−0.086; 95% CI, −0.154 to −0.018) and 5 half-years (−0.106; 95% CI, −0.184 to −0.028) after implementation. Results differed slightly depending on the reference period used, and hospital-specific models showed substantial heterogeneity in program outcomes across facilities.Conclusions and RelevanceIn this cohort study of patients treated for opioid overdose, OORP implementation was associated with an increase in MOUD initiation and a decrease in repeat medically treated overdoses. The large variation in outcomes across hospitals suggests that treatment effects were heterogeneous and may depend on factors such as implementation success, program embeddedness, and availability of other hospital- and community-based OUD services.

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Section: Discussionmentioning

confidence: 99%

Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose

Treitler,

Crystal,

Cantor

et al. 2024

JAMA Netw Open

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“…For patients with opioid use disorder (OUD), EDs have expanded lifesaving buprenorphine prescribing and take-home naloxone programs nationwide, 20,21 activities that undoubtedly have improved the care for patients with OUD. [22][23][24] In contrast, there is currently a paucity of pharmacotherapy, psychosocial interventions, and harm reduction strategies targeting patients with methamphetamine use disorder. In this study our primary objective was to identify the motivations of people who use methamphetamine and their experiences in the ED.…”

Section: Introductionmentioning

confidence: 99%

“That Line Just Kept Moving”: Motivations and Experiences of People Who Use Methamphetamine

Fockele

Morse

Draanen³

et al. 2023

WestJEM

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Introduction: Methamphetamine use is on the rise with increasing emergency department (ED) visits, behavioral health crises, and deaths associated with use and overdose. Emergency clinicians describe methamphetamine use as a significant problem with high resource utilization and violence against staff, but little is known about the patient’s perspective. In this study our objective was to identify the motivations for initiation and continued methamphetamine use among people who use methamphetamine and their experiences in the ED to guide future ED-based approaches. Methods: This was a qualitative study of adults residing in the state of Washington in 2020, who used methamphetamine in the prior 30 days, met criteria for moderate- to high-risk use, reported recently receiving care in the ED, and had phone access. Twenty individuals were recruited to complete a brief survey and semistructured interview, which was recorded and transcribed prior to being coded. Modified grounded theory guided the analysis, and the interview guide and codebook were iteratively refined. Three investigators coded the interviews until consensus was reached. Data was collected until thematic saturation. Results: Participants described a shifting line that separates the positive attributes from the negative consequences of using methamphetamine. Many initially used methamphetamine to enhance social interactions, combat boredom, and escape difficult circumstances by numbing the senses. However, continued use regularly led to isolation, ED visits for the medical and psychological sequelae of methamphetamine use, and engagement in increasingly risky behaviors. Because of their overwhelmingly frustrating experiences in the past, interviewees anticipated difficult interactions with healthcare clinicians, leading to combativeness in the ED, avoidance of the ED at all costs, and downstream medical complications. Participants desired a non-judgmental conversation and linkage to outpatient social resources and addiction treatment. Conclusion: Methamphetamine use can lead patients to seek care in the ED, where they often feel stigmatized and are provided little assistance. Emergency clinicians should acknowledge addiction as a chronic condition, address acute medical and psychiatric symptoms adequately, and provide positive connections to addiction and medical resources. Future work should incorporate the perspectives of people who use methamphetamine into ED-based programs and interventions.

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“… 8 – 14 Further, a recent community-based study by Le et al demonstrated decreased subsequent healthcare utilization at 12 months after initiation of MOUD in the ED. 15 …”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14] Further, a recent community-based study by Le et al demonstrated decreased subsequent healthcare utilization at 12 months after initiation of MOUD in the ED. 15 Most ED-initiated MOUD studies have focused on treatment retention in large, urban, academic medical centers outside the Southeast or subsequent healthcare utilization in community hospitals. 7,11,12,15,16 Our large, urban, academic ED in the Southeast offers a unique perspective on the impact of ED-initiated MOUD on healthcare utilization in a resource-limited region characterized by persistent Medicaid non-expansion, high poverty rates, and healthcare access challenges.…”

Section: Introductionmentioning

confidence: 99%

“…15 Most ED-initiated MOUD studies have focused on treatment retention in large, urban, academic medical centers outside the Southeast or subsequent healthcare utilization in community hospitals. 7,11,12,15,16 Our large, urban, academic ED in the Southeast offers a unique perspective on the impact of ED-initiated MOUD on healthcare utilization in a resource-limited region characterized by persistent Medicaid non-expansion, high poverty rates, and healthcare access challenges. 13 In this study, we investigated whether EDinitiated bup/nx also impacts acute healthcare utilization, specifically repeat ED visits, for ED OUD patients.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Emergency Department-Initiated Buprenorphine on Repeat Emergency Department Utilization

Skains,

Reynolds,

Carlisle

et al. 2023

WestJEM

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Introduction Recent studies have demonstrated the promise of emergency department (ED)-initiated buprenorphine/naloxone (bup/nx) for improving 30-day retention in outpatient addiction care programs for patients with opioid use disorder (OUD). We investigated whether ED-initiated bup/nx for OUD also impacts repeat ED utilization. Methods We performed a retrospective chart review of ED patients discharged with a primary diagnosis of OUD from July 2019–December 2020. Characteristics considered included age, gender, race, insurance status, domicile status, presence of comorbid Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis, presenting chief complaint, and provision of a bup/nx prescription and/or naloxone kit. Primary outcomes included repeat ED visit (opioid or non-opioid related) within 30 days, 90 days, and one year. Statistical analyses included bivariate comparison and Poisson regression. Results Of 169 participants, the majority were male (67.5%), White (82.8%), uninsured (72.2%), and in opioid withdrawal and/or requesting “detox” (75.7%). Ninety-one (53.8%) received ED-initiated bup/nx, which was independent of age, gender, race, insurance status, presence of comorbid DSM-5 diagnosis, or domicile status. Naloxone was more likely to be provided to patients who received bup/nx (97.8% vs 26.9%; P < 0.001), and bup/nx was more likely to be given to patients who presented with opioid withdrawal and/or requested “detox” (63.3% vs 36.7%; P < 0.001). Bup/nx provision was associated with decreased ED utilization for opioid-related visits at 30 days ( P = 0.04). Homelessness and lack of insurance were associated with increased ED utilization for non-opioid-related visits at 90 days ( P = 0.008 and P = 0.005, respectively), and again at one year for homelessness ( P < 0.001). When controlling for age and domicile status, the adjusted incidence rate ratio for overall ED visits was 0.56 (95% confidence interval [CI] 0.33–0.96) at 30 days, 0.43 (95% CI 0.27–0.69) at 90 days, and 0.60 (95% CI 0.39–0.92) at one year, favoring bup/nx provision. Conclusion Initiation of bup/nx in the ED setting was associated with decreased subsequent ED utilization. Socioeconomic factors, specifically health insurance and domicile status, significantly impacted non-opioid-related ED reuse. These findings demonstrate the ED’s potential as an initiation point for bup/nx and highlight the importance of considering the social risk and social need for OUD patients.

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Healthcare Use After Buprenorphine Prescription in a Community Emergency Department: A Cohort Study

Cited by 7 publications

References 19 publications

Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose

Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose

“That Line Just Kept Moving”: Motivations and Experiences of People Who Use Methamphetamine

Impact of Emergency Department-Initiated Buprenorphine on Repeat Emergency Department Utilization

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