(O-E2) Buprenorphine Initiation for Opioid Use Disorder in the Emergency Department: Impact on Patient Outcomes in at a Community Hospital

Objectives: To investigate the impact of emergency department-initiated buprenorphine in comparison to current standard of care on various patient outcomes. The current standard of care will constitute the retrospective variable of the study while the emergency department-initiated buprenorphine protocol will constitute the prospective variable.

Background: Buprenorphine has been shown to be safe and effective in preventing withdrawal symptoms of Opioid Used Disorder (OUD) and subsequent relapse into uncontrolled substance use. No standardized protocol currently exists for the treatment of OUD in the ED, and management has traditionally been at the discretion of the physician. This study examines the initiation of a department-based protocol based on documented Clinical Opiate Withdrawal Scale (COWS) score of prescribing buprenorphine in the eligible population, and following patient outcomes over a short-term interval (30 days from enrollment).

Methods: This is a single center, cohort study set up with two phases. A retrospective phase which consisted of review of standard of care patients from October 2020 to January 2021, and a prospective phase where an Emergency Department Initiated buprenorphine protocol was implemented from October 2021 to January 2022. The inclusion criteria for the buprenorphine protocol included the following: patients 18 years of age and older who meet DSM-5 criteria for OUD, patients seeking outpatient detoxification treatment with buprenorphine, and patients who were offered Peer Recovery Program (PRP) services. Exclusion criteria included: medical or psychiatric conditions requiring hospitalization, patients actively participating in methadone maintenance program, history of allergic reactions to buprenorphine. The primary outcome evaluated was readmission to the ED for OUD within 30 days of initial discharge. The secondary outcomes included: admission to an Outpatient Treatment Program through the facilitation of PRP, readmission to the ED for opioid-involved overdoses requiring naloxone administration, readmission to the ED for any reason, acceptance of PRP Recovery Specialist services, acceptance of PRP Patient Navigator Services, and follow-up with the PRP.

Results: There were 85 total patients enrolled in this study of similar race, gender, age and drug of abuse. The primary outcome of readmission to the ED for OUD within 30 days of initial discharge, was 15% in the retrospective phase and 5% in the prospective phase with a p-value of 0.17. In the secondary outcomes, 9% of patients had admission to an Outpatient Treatment Program vs. 17% in the prospective phase with a p-value of 0.32. In the retrospective group 98% of patients accepted PRP services compared to 90%, with a p-value of 0.17. In the retrospective group, 25% of patients accepted PRP Patient Navigator Services vs. 44% with a p-value of 0.11. The retrospective group included 13% of patients involved in an overdose requiring naloxone administration vs 0% with a p-value of 0.03. The retrospective group had 35% of patients with readmission to the ED for any reason vs. 13% of patients with a p-value of 0.18. Additionally, 41% of patients in the retrospective group followed up with the PRP vs. 44% in the prospective group with a p-value of 1.00.

Conclusions: The ED-initiated buprenorphine protocol led to a reduction in readmissions for any reason, readmission for OUD, and overdoses requiring naloxone. There was an increase in admissions to an Outpatient Treatment Program through PRP facilitation, and acceptance of PRP Services. Limitations and low adherence rate may influence results. The next steps include continued enrollment, re-education on protocol and monitoring long term outcomes.

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Funding (Optional): N/A