NUBE 2025

Background: The United States continues to be in the midst of an opioid epidemic with the number of deaths due to overdose compounding each year. Although various measures have been employed to fight this epidemic, improving medication access is paramount. Buprenorphine is a very effective medication for OUD (opioid use disorder) that can significantly reduce the risk of overdose and improve recovery outcomes. The emergency department (ED) is primed to serve as an effective access point for initiating OUD (opioid use disorder) treatment, offering utility and ease of access to buprenorphine for patients in need.

Our poster presents a literature review of buprenorphine induction in the ED.

Methods: A systematic literature review was carried out based on the PRISMA model on PubMed. Search terms included (buprenorphine OR suboxone) AND (opioid use disorder OR Opiate misuse OR opioid abuse) AND (management OR treatment) AND (psychiatric emergency room OR CPEP). Papers published between 2012-2024 were included in this literature review. The literature review led to an initial discovery of 69 hits on Pubmed. After abstracts were reviewed for relevance, 28 comprised randomized clinical trials, observational studies, and implementation protocols.

Results: ED-initiated buprenorphine significantly improved patient engagement in addiction treatment at 30 days (78%) in comparison with a brief intervention (45%). It also led to higher retention rates (62-65%) and follow-ups indicating the potential for long-term sustained recovery. The effect of high-dose induction (up to 32mg) was studied which showed its effectiveness in rapidly stabilizing patients. From a financial standpoint, ED-initiated buprenorphine proved to be cost-effective ($54,000 per quality-adjusted life year) compared to standard care. However, there exist barriers to effective implementation such as additional clinician training and infrastructure that may not be available in EDs nationwide. For the maintenance of sustained treatment, ongoing support and resources are pivotal, requiring an integrated care model with ED physicians, primary care doctors, and psychiatrists.

Discussion/Conclusion: This literature review emphasizes the importance of buprenorphine induction in the ED as an effective and economic intervention for OUD. Evidence in the literature indicates improved patient engagement and better long-term outcomes. Future research should focus on understanding barriers to initiation to ensure equitable access, optimizing its implementation by training providers, having standardized treatment protocols, and providing appropriate referral channels.

Learning Objectives:

Understand the impact of ED-initiated buprenorphine on OUD treatment.

Identify barriers and challenges in implementing buprenorphine induction in the ED.

Discuss the role of integrated care models in supporting ED-initiated buprenorphine treatment.