Rates of substance use disorder treatment seeking visits after emergency department-initiated buprenorphine

Jennings, Lindsey; Bogan, Carolyn; McCauley, Jenna L.; Moreland, Angela D.; Lane, Suzanne; Ward, Ralph; Hartwell, Karen J.; Haynes, Louise; Brady, Kathleen T.

doi:10.1016/j.ajem.2020.02.011

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…47,50 ED administrators have voiced concern that offering ED-based buprenorphine induction might increase the volume of patients presenting with substance use disorders, but an analysis of ED volumes after introduction of induction services at one ED suggests this not to be the case. 55 In rural areas, the physical distance between ED and medicated-assisted treatment (MAT) facilities and sparse distribution of X-waivered providers to provide follow-up care pose major barriers to successful buprenorphine programs. 56,57 In the US, 56% of rural counties lack a X-waivered physician to prescribe buprenorphine.…”

Section: Alternatives To Buprenorphine Inductionmentioning

confidence: 99%

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

Cao¹,

Dunham²,

Simpson³

2020

OAEM

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ED-initiated addiction treatment holds promise for enhancing access to treatment for those with opioid use disorder (OUD). We present a literature review summarizing the evidence for buprenorphine induction in the ED including best practices for dosing, follow-up care, and reducing implementation barriers. A literature search of Pubmed, PsychInfo, and Embase identified articles studying OUD treatment in the ED published after 1980. Twenty-five studies were identified including eleven scientific abstracts. Multiple studies suggest that buprenorphine induction improves engagement in substance treatment up to 30 days after ED treatment. Many different induction protocols were presented, but no particular approach was best supported as criteria for induction and initial dosing vary widely. Similarly, transition of care models focused on either a "hub and spoke" model or "warm hand-offs" model, but no studies compared these approaches. Common barriers to implementing induction programs were provider inexperience, discomfort with addiction treatment, and limited time during the ED visit. No studies described the number of EDs offering induction. While ED buprenorphine induction is safe and enhances adherence to addiction treatment, uncertainty persists in how to best identify patients needing treatment, how to initiate buprenorphine, and how to enhance follow-up after ED-initiated treatment.

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Section: Alternatives To Buprenorphine Inductionmentioning

confidence: 99%

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

Cao¹,

Dunham²,

Simpson³

2020

OAEM

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“…Protocols for ED-initiated buprenorphine have also been found to streamline care 4 within the ED without increasing ED visits for substance use treatment. 25 Regional standards around OUD treatment and referral may boost mission-driven practice, gain patient trust, address outpatient providers' skepticism, and reduce treatment disparities.…”

Section: Discussionmentioning

confidence: 99%

Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington

et al. 2021

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Study objective Opioid use disorder (OUD) is on the rise nationwide with increasing emergency department (ED) visits and deaths secondary to overdose. Although previous research has shown that patients who are started on buprenorphine in the ED have increased engagement in addiction treatment, access to on‐demand medications for OUD is still limited, in part because of the need for linkages to outpatient care. The objective of this study is to describe emergency and outpatient providers’ perception of local barriers to transitions of care for ED‐initiated buprenorphine patients. Methods Purposive sampling was used to recruit key stakeholders, identified as physicians, addiction specialists, and hospital administrators, from 10 EDs and 11 outpatient clinics in King County, Washington. Twenty‐one interviews were recorded and transcribed and then coded using an integrated deductive and inductive content analysis approach by 2 team members to verify accuracy of the analysis. Interview guides and coding were informed by the Consolidated Framework for Implementation Research (CFIR), which provides a structure of domains and constructs associated with effective implementation of evidence‐based practice. Results From the 21 interviews with emergency and outpatient providers, this study identified 4 barriers to transitions of care for ED‐initiated buprenorphine patients: scope of practice, prescribing capacity, referral incoordination, and loss to follow‐up. Conclusion Next steps for implementation of this intervention in a community setting include establishing a standard of care for treatment and referral for ED patients with OUD, increasing buprenorphine prescribing capacity, creating a central repository for streamlined referrals and follow‐up, and supporting low‐barrier scheduling and navigation services.

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“…Finally, states can shape what treatment options patients have access to by determining coverage for MOUD, widely considered the gold-standard for OUD treatment. State coverage of MOUD was based on responses to the 2015 National Association of State Alcohol and Drug Abuse Directors questionnaire [ 24 ]. After accounting for missing data, the analytic sample for the study included 457 hospitals across 49 states (see Additional file 1: Appendix Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…These services can include programs aimed at prevention, early intervention, and treatment services directly provided or indirectly supported by hospitals. Such hospital-based or initiated OUD services can lead to high treatment engagement as well as provide successful linkages to outpatient care [22][23][24][25][26][27]. These hospital-based OUD programs are likely to be more critical given the rise in opioid-related overdoses and hospitalizations following the onset of Covid-19.…”

Section: Introductionmentioning

confidence: 99%

Association of Medicaid expansion and 1115 waivers for substance use disorders with hospital provision of opioid use disorder services: a cross sectional study

Chang

Cronin

Lindenfeld

et al. 2023

BMC Health Serv Res

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Introduction Opioid-related hospitalizations have risen dramatically, placing hospitals at the frontlines of the opioid epidemic. Medicaid expansion and 1115 waivers for substance use disorders (SUDs) are two key policies aimed at expanding access to care, including opioid use disorder (OUD) services. Yet, little is known about the relationship between these policies and the availability of hospital based OUD programs. The aim of this study is to determine whether state Medicaid expansion and adoption of 1115 waivers for SUDs are associated with hospital provision of OUD programs. Methods We conducted a cross-sectional study of a random sample of hospitals (n = 457) from the American Hospital Association’s 2015 American Hospital Directory, compiled with the most recent publicly available community health needs assessment (2015–2018). Results Controlling for hospital characteristics, overdose burden, and socio-demographic characteristics, both Medicaid policies were associated with hospital adoption of several OUD programs. Hospitals in Medicaid expansion states had significantly higher odds of implementing any program related to SUDs (OR: 1.740; 95% CI: 1.032–2.934) as well as some specific activities such as programs for OUD treatment (OR: 1.955; 95% CI: 1.245–3.070) and efforts to address social determinants of health (OR: 6.787; 95% CI: 1.308–35.20). State 1115 waivers for SUDs were not significantly associated with any hospital-based SUD activities. Conclusions Medicaid expansion was associated with several hospital programs for addressing OUD. The differential availability of hospital-based OUD programs may indicate an added layer of disadvantage for low-income patients with SUD living in non-expansion states.

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Rates of substance use disorder treatment seeking visits after emergency department-initiated buprenorphine

Cited by 6 publications

References 6 publications

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

Improving transitions of care for patients initiated on buprenorphine for opioid use disorder from the emergency departments in King County, Washington

Association of Medicaid expansion and 1115 waivers for substance use disorders with hospital provision of opioid use disorder services: a cross sectional study

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