Common Factors Across Four Emergency Department-initiated Buprenorphine Programs

The emergency department (ED) is a setting that offers opportunities to deliver opioid use disorder (OUD) treatment. Notably, the American College of Emergency Physicians recommends the provision of buprenorphine to patients with OUD. This article describes the successful implementation of buprenorphine initiation programs in 4 US EDs, and identifies key common facilitators.

• Integration of information technology and electronic medical record Information technology is useful in assisting screening/case finding (including with machine learning methods), workflow, and prescription orders. Clinician decision support helps minimize barriers to prescribing. Clinical pathways enhance evidence-based practice (by providing template order sets, prescriptions, referral information, instructions, etc.).
• A clinical champion/early adopter, and support from ED and hospital leadership are key to developing a culture favorable to buprenorphine programs. An ED physician clinical champion can disseminate information to clinical staff, provide consultations, and assist with prescriptions. Building a medical team of waivered physicians is key, allowing for ED autonomy in buprenorphine initiation. Fostering a culture of treatment of OUD and OUD education (in the broader context of the public health role of the ED) can impact residents and create practice changes.
• Collaboration with pharmacies is important in establishing guidelines and processes to administer buprenorphine in the ED.
• Connection with outpatient partners. The link with outpatient care is crucial and all programs relied on strong connections with proximal outpatient partners.
• Quality improvement processes—performed by local champions with feedback on successes—help enhance practice change.

Comments: This manuscript reports that implementation of ED-initiated buprenorphine is feasible. Implementation models relied on local champions and were adapted to local characteristics and resources to identify patients and provide treatment and referral to outpatient care. Common factors across all 4 sites related to information technology, ED culture, hospital-level support, and connection with outpatient facilities.

Nicolas Bertholet, MD, MSc

Reference: Whiteside LK, D’Onofrio G, Fiellin DA, et al. Models for implementing emergency department-initiated buprenorphine with referral for ongoing medication treatment at emergency department discharge in diverse academic centers. Ann Emerg Med. 2022;80(5):410–419.