Initiation of Buprenorphine in the Emergency Department Increased Opioid Treatment Engagement at 30 Days

Patients with opioid use disorder frequently seek care in the emergency department (ED), which presents an opportunity to link them to addiction treatment. Researchers randomized 329 ED patients with DSM IV opioid dependence to 1 of 3 groups: referral to treatment; brief intervention and a facilitated referral (BIRT); and BIRT with buprenorphine initiation and clinical follow-up. The main outcome was enrollment in addiction treatment 30 days after the ED visit. Secondary outcomes included illicit opioid use, by self-report and urine toxicology testing, and inpatient addiction treatment service use.

• 66% were identified by screening and 34% were seeking treatment for opioid use disorder.
• 75% were using heroin primarily, 25% were using prescription opioids primarily, and 52% were injecting drugs.
• 78% of the patients in the buprenorphine group were engaged in addiction treatment at 30 days, as compared with 45% in the BIRT group, and 37% in the referral-only group.
• Those in the buprenorphine group also had lower utilization of inpatient addiction treatment (11% versus 35% in BIRT and 37% in referral only).
• The buprenorphine group reported a greater decrease in illicit opioid use than the other groups; however there was no significant difference in urine toxicology results across groups.

Comments:

This study demonstrates that initiating opioid agonist therapy in the ED results in better engagement in addiction treatment among patients who are either treatment-seeking or identified by screening. Beginning buprenorphine in the ED increased engagement in addiction treatment generally, but decreased use of inpatient treatment, compared with those receiving referral alone or brief intervention with referral. No impact of brief intervention was detected over referral alone.

Zoe M. Weinstein, MD† and Alexander Y. Walley, MD, MSc

Reference:

D’Onofrio G, O’Connor PG, Pantalon MV, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636–1644.