Emergency department‐initiated buprenorphine protocols: A national evaluation
Abstract Objective Emergency department‐initiated buprenorphine (BUP) for opioid use disorder is an evidence‐based practice, but limited data exist on BUP initiation practices in real‐world settings. We sought to characterize protocols for BUP initiation among a geographically diverse sample of emer...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-12-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12606 |
| _version_ | 1819175511997284352 |
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| author | Clara Z. Guo Gail D'Onofrio David A. Fiellin E. Jennifer Edelman Kathryn Hawk Andrew Herring Ryan McCormack Jeanmarie Perrone Ethan Cowan |
| author_facet | Clara Z. Guo Gail D'Onofrio David A. Fiellin E. Jennifer Edelman Kathryn Hawk Andrew Herring Ryan McCormack Jeanmarie Perrone Ethan Cowan |
| author_sort | Clara Z. Guo |
| collection | DOAJ |
| description | Abstract Objective Emergency department‐initiated buprenorphine (BUP) for opioid use disorder is an evidence‐based practice, but limited data exist on BUP initiation practices in real‐world settings. We sought to characterize protocols for BUP initiation among a geographically diverse sample of emergency departments (EDs). Methods In December 2020, we reviewed prestudy clinical BUP initiation protocols from all EDs participating in CTN0099 Emergency Department‐INitiated bupreNOrphine VAlidaTION (ED‐INNOVATION). We abstracted information on processes for identification of treatment‐eligible patients, BUP administration, and discharge care. Results All participating ED‐INNOVATION sites across 22 states submitted protocols; 31 protocols were analyzed. Identification of treatment‐eligible patients: Most EDs 22 (71%) relied on clinician judgment to determine appropriateness of BUP treatment with only 7 (23%) requiring decision support tools or diagnosis checklists. Before BUP initiation, 27 (87%) protocols required a documented Clinical Opiate Withdrawal Scale (COWS) score; 4 (13%) required a clinical diagnosis of withdrawal with optional COWS score. Twenty‐seven (87%) recommended a minimum COWS score of 8 for ED‐initiated BUP. BUP administration: Initial BUP dose ranged from 2–16 mg (mode = 4). For continued withdrawal symptoms, 27 (87%) protocols recommended an interval of 30–60 minutes between first and second BUP dose. Total BUP dose in the ED ranged from 8 to 32 mg. Discharge care: Twenty‐eight (90%) protocols recommended a BUP prescription (mode 16 mg daily) at discharge. Naloxone prescription and/or provision was suggested in 23 (74%) protocols. Conclusions In this geographically diverse sample of EDs, protocols for ED‐initiated BUP differed between sites. Future work should evaluate the association between this variation and patient outcomes. |
| first_indexed | 2024-12-22T20:56:02Z |
| format | Article |
| id | doaj.art-67a6241e1ce04c73b89434f99d616fc5 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-12-22T20:56:02Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-67a6241e1ce04c73b89434f99d616fc52022-12-21T18:12:56ZengWileyJournal of the American College of Emergency Physicians Open2688-11522021-12-0126n/an/a10.1002/emp2.12606Emergency department‐initiated buprenorphine protocols: A national evaluationClara Z. Guo0Gail D'Onofrio1David A. Fiellin2E. Jennifer Edelman3Kathryn Hawk4Andrew Herring5Ryan McCormack6Jeanmarie Perrone7Ethan Cowan8Yale University School of Medicine New Haven Connecticut USADepartment of Emergency Medicine Yale University School of Medicine New Haven Connecticut USADepartment of Internal Medicine Yale University School of Medicine New Haven Connecticut USADepartment of Internal Medicine Yale University School of Medicine New Haven Connecticut USADepartment of Emergency Medicine Yale University School of Medicine New Haven Connecticut USADepartment of Emergency Medicine Highland Hospital – Alameda Health System University of California San Francisco California USADepartment of Emergency Medicine New York University School of Medicine New York New York USADepartment of Emergency Medicine Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania USADepartment of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USAAbstract Objective Emergency department‐initiated buprenorphine (BUP) for opioid use disorder is an evidence‐based practice, but limited data exist on BUP initiation practices in real‐world settings. We sought to characterize protocols for BUP initiation among a geographically diverse sample of emergency departments (EDs). Methods In December 2020, we reviewed prestudy clinical BUP initiation protocols from all EDs participating in CTN0099 Emergency Department‐INitiated bupreNOrphine VAlidaTION (ED‐INNOVATION). We abstracted information on processes for identification of treatment‐eligible patients, BUP administration, and discharge care. Results All participating ED‐INNOVATION sites across 22 states submitted protocols; 31 protocols were analyzed. Identification of treatment‐eligible patients: Most EDs 22 (71%) relied on clinician judgment to determine appropriateness of BUP treatment with only 7 (23%) requiring decision support tools or diagnosis checklists. Before BUP initiation, 27 (87%) protocols required a documented Clinical Opiate Withdrawal Scale (COWS) score; 4 (13%) required a clinical diagnosis of withdrawal with optional COWS score. Twenty‐seven (87%) recommended a minimum COWS score of 8 for ED‐initiated BUP. BUP administration: Initial BUP dose ranged from 2–16 mg (mode = 4). For continued withdrawal symptoms, 27 (87%) protocols recommended an interval of 30–60 minutes between first and second BUP dose. Total BUP dose in the ED ranged from 8 to 32 mg. Discharge care: Twenty‐eight (90%) protocols recommended a BUP prescription (mode 16 mg daily) at discharge. Naloxone prescription and/or provision was suggested in 23 (74%) protocols. Conclusions In this geographically diverse sample of EDs, protocols for ED‐initiated BUP differed between sites. Future work should evaluate the association between this variation and patient outcomes.https://doi.org/10.1002/emp2.12606buprenorphine protocolemergency departmentopioid use disorderopioid withdrawal |
| spellingShingle | Clara Z. Guo Gail D'Onofrio David A. Fiellin E. Jennifer Edelman Kathryn Hawk Andrew Herring Ryan McCormack Jeanmarie Perrone Ethan Cowan Emergency department‐initiated buprenorphine protocols: A national evaluation Journal of the American College of Emergency Physicians Open buprenorphine protocol emergency department opioid use disorder opioid withdrawal |
| title | Emergency department‐initiated buprenorphine protocols: A national evaluation |
| title_full | Emergency department‐initiated buprenorphine protocols: A national evaluation |
| title_fullStr | Emergency department‐initiated buprenorphine protocols: A national evaluation |
| title_full_unstemmed | Emergency department‐initiated buprenorphine protocols: A national evaluation |
| title_short | Emergency department‐initiated buprenorphine protocols: A national evaluation |
| title_sort | emergency department initiated buprenorphine protocols a national evaluation |
| topic | buprenorphine protocol emergency department opioid use disorder opioid withdrawal |
| url | https://doi.org/10.1002/emp2.12606 |
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