Barriers and Facilitators to Clinician Readiness to Provide Emergency Department–Initiated Buprenorphine

Hawk, Kathryn; D’Onofrio, Gail; Chawarski, Marek C.; O’Connor, Patrick G.; Cowan, Ethan; Lyons, Michael S.; Richardson, Lynne D.; Rothman, Richard E.; Whiteside, Lauren K.; Owens, Pamela L; Martel, Shara; Coupet, Edouard; Pantalon, Michael V.; Curry, Leslie; Fiellin, David A.; Edelman, E. Jennifer

doi:10.1001/jamanetworkopen.2020.4561

Cited by 104 publications

(172 citation statements)

References 35 publications

(84 reference statements)

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“…Another possible facilitator noted by both Hawk et al and Im et al was feedback to clinicians about patient success stories from those who had been initiated on BUP in the ED; as our participants noted, the positive responses from patients in the ED became self-reinforcing as more comfort with BUP developed over time. 18,19 Once treatment protocols, physician training, follow-up pathways, and other supports have been implemented, emergency physicians report that joint patient and ED system engagement becomes the limiting factor in treatment uptake. This is complicated by the stigma that remains pervasive, particularly around illegal drug use.…”

Section: Discussionmentioning

confidence: 99%

“…Barriers to BUP initiation are well documented, particularly those perceived by US clinicians who have little to no experience with BUP; 18,19 however, there is relatively little research that has examined the perceived facilitators of BUP initiation among emergency physicians with a range of experiences administering the treatment in the ED. Clinicians' attitudes regarding BUP initiation have been reported…”

Section: Importancementioning

confidence: 99%

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Emergency physician perspectives on initiating buprenorphine/naloxone in the emergency department: A qualitative study

et al. 2021

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Objectives:The objective of this study was to examine the perspectives of Canadian emergency physicians on the care of patients with opioid use disorders in the emergency department (ED), in particular the real-world facilitators to prescribing buprenorphine/naloxone (BUP) in the ED. Methods:We conducted semistructured qualitative interviews using a multi-sitefocused ethnographic design. Purposive sampling via an existing national research network was used to recruit ED physicians. Interviews were conducted by phone using an interview guide and continued until theoretical data saturation was reached. Interviews were transcribed and analyzed using latent content analysis. Interviews took

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Section: Discussionmentioning

confidence: 99%

Section: Importancementioning

confidence: 99%

Emergency physician perspectives on initiating buprenorphine/naloxone in the emergency department: A qualitative study

et al. 2021

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“…For ED OAT interventions to be scaled-up and sustained, a number of barriers ranging from physician readiness, lack of formal training, time constraints, and absence of community-based referral networks to ensure longer-term retention need to be successfully addressed. 34…”

Section: Discussionmentioning

confidence: 99%

“…While further research is needed, EDs are an appropriate setting for OAT initiation and a key entry point into lifesaving treatment for substance use disorders. For ED OAT interventions to be scaled‐up and sustained, a number of barriers ranging from physician readiness, lack of formal training, time constraints, and absence of community‐based referral networks to ensure longer‐term retention need to be successfully addressed 34 …”

Section: Discussionmentioning

confidence: 99%

Emergency Department–initiated Interventions for Patients With Opioid Use Disorder: A Systematic Review

Kaczorowski

Bilodeau

Orkin

et al. 2020

Academic Emergency Medicine

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Objectives: The opioid crisis has risen dramatically in North America in the new millennium, due to both illegal and prescription opioid use. While emergency departments (EDs) represent a potentially strategic setting for interventions to reduce harm from opioid use disorder (OUD), the absence of a recent synthesis of literature limits implementation and scalability. To fill this gap, we conducted a systematic review of the literature on interventions targeting OUDs initiated in EDs. Methods: Using an explicit search strategy (PROSPERO), the MEDLINE, CINAHL Complete, EMBASE, and EBM reviews databases were searched from 1980 to October 4, 2019. The gray literature was explored using Google Scholar. Study characteristics were abstracted independently. The methodologic quality and risk of bias were assessed. Results: Twelve of 2,270 studies met the inclusion criteria (two of high quality). In addition to the heterogeneity of the outcome measures used (retention in treatment, opioid consumption, and overdose), brief intervention and buprenorphine initiation (six of 12 studies) were the most documented with mixed effects for the former and positive short-term and confined to single ED sites effects for the latter. Conclusion: Emergency departments can be an appropriate setting for initiating opioid agonist treatment, but to be sustained, it likely needs to be coupled with community-based follow-up and support to ensure longer-term retention. The scarcity of high-quality evidence on OUD interventions initiated in emergency settings highlights the need for future research. O pioid use disorder (OUD) and opioid-related deaths have risen dramatically in North America in the new millennium and now reach epidemic proportions. 1,2 In the United States, opioid-related deaths increased by 345% from 9,489 to 42,245 between 2001 and 2016 (3.3 to 13.1 deaths per 100,000 population). 3 This crisis has reduced overall life expectancy in British Columbia, the Canadian province where the highest death rates have occurred. 4 In the past 3 years, the opioid-related deaths in Canada have

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“…The first submenu strategy is adding and/or expanding MOUD treatment in primary care, other general medical and mental health settings and substance use disorder treatment and recovery programs. Historically in the US, addiction treatment has been isolated from general medical and mental health care settings, and MOUD treatment has been omitted from the care provided in primary care, hospitals ( Fanucchi and Lofwall, 2016 ; Jicha et al, 2019 ), emergency departments ( Hawk et al, 2020 ), and general mental health ( Novak et al, 2019 ). Furthermore, according to data from the National Survey of Substance Abuse Treatment Facilities, many substance use disorder treatment programs do not provide MOUD ( Substance Abuse and Mental Health Services Administration, 2019c ).…”

Section: Methodsmentioning

confidence: 99%

The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study

Winhusen¹,

Walley²,

Fanucchi³

et al. 2020

Drug and Alcohol Dependence

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Highlights An approach to community implementation of evidence-based practices (EBPs) was needed. The Opioid-overdose Reduction Continuum of Care Approach (ORCCA) was developed. ORCCA outlines: evidence-based strategies, priority populations, community settings. ORCCA is a flexible framework for EBP implementation to reduce opioid-overdose deaths.

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Barriers and Facilitators to Clinician Readiness to Provide Emergency Department–Initiated Buprenorphine

Cited by 104 publications

References 35 publications

Emergency physician perspectives on initiating buprenorphine/naloxone in the emergency department: A qualitative study

Emergency physician perspectives on initiating buprenorphine/naloxone in the emergency department: A qualitative study

Emergency Department–initiated Interventions for Patients With Opioid Use Disorder: A Systematic Review

The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study

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