Emergency Department Initiation of Buprenorphine for Opioid Use Disorder: Current Status, and Future Potential

Fox, Lindsay; Nelson, Lewis S.

doi:10.1007/s40263-019-00667-7

Cited by 19 publications

(24 citation statements)

References 41 publications

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“…The growing use of EDs related to opioid poisoning and OUD offers both challenges and opportunities to screen for OUD and initiate interventions and referrals aiming to counter this crisis in a strategic location 1,8,9 . EDs have long been recognized as a primary access point to the health care system for many Americans and Canadians alike, particularly for subgroups of the population that suffer disproportionately from OUD.…”

mentioning

confidence: 99%

“…Brief, evidence-based and scalable ED interventions could be a major step forward to address the opioid crisis. 1,9 The growing concern about the opioid crisis has stimulated research, cross-border knowledge sharing, and health system-level initiatives. 12,13 Several literature reviews related to the opioid crisis have been recently completed to inform clinicians and decision makers on the effectiveness of different strategies and to summarize the state of knowledge in this area.…”

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confidence: 99%

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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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confidence: 99%

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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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“…Buprenorphine is most effective at reducing mortality and hospitalisation when maintained for at least 12 months compared to discontinuation within 5 months 31 . This disparity between the 2 and 6 and 12 month results show the importance of not only initiating buprenorphine but facilitating its maintenance by direct and supportive communication to community care 32 . This has been termed a ‘warm handover’.…”

Section: Resultsmentioning

confidence: 99%

“…31 This disparity between the 2 and 6 and 12 month results show the importance of not only initiating buprenorphine but facilitating its maintenance by direct and supportive communication to community care. 32 This has been termed a 'warm handover'.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

Review article: Rapid review of the emergency department‐initiated buprenorphine for opioid use disorder

Salter

Hutton

Cantwell

et al. 2020

Emerg Medicine Australasia

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Opioid-related harms have been increasing in Australia over the last 5 years. Patients with opioid use disorder are over-represented in ED presentations. Opioid agonist treatment is the most effective community-based treatment. Buprenorphine is considered the safest of these treatments to use in the ED setting. This rapid review investigated the effectiveness of initiating buprenorphine in the ED setting. Medline, Embase, Emcare, PSYCinfo, CINAHL and Cochrane Central Register of Controlled Trials databases were searched. Randomised and non-randomised studies published in peer-reviewed journals that involved the initiation of buprenorphine in the ED setting were considered eligible. The search revealed 350 articles of which 11 were included in the review; three articles representing two randomised controlled trials (RCTs) and eight observational studies. Data were extracted from included papers and risk of bias assessed on the RCTs. One well-conducted RCT showed that buprenorphine initiated in the ED does improve treatment engagement up to 2 months after an ED visit. Eight observational studies, one with a comparator group reported positive results for this intervention. There is strong evidence that clinicians should consider commencing buprenorphine in the ED for patients with opioid use disorder when combined with a direct and supported referral or 'warm handover' to community care. Further implementation studies and investigation of long-acting injectable buprenorphine treatment are required.

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“…We believe the theory also indicates concerns about precipitating withdrawal and interacting drugs and alcohol apply to an even greater extent for naloxone. In contrast, using sublingual buprenorphine in the ED is beneficial in starting the process of buprenorphine maintenance therapy and thus in harm reduction and reducing further overdoses and deaths [9]. Further evidence from other settings are definitely needed to withdraw more robust results.…”

mentioning

confidence: 99%

Naloxone should remain the appropriate antidote to treat opioid overdose

Mégarbane¹,

Chevillard²,

Vodovar³

2020

Crit Care

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Emergency Department Initiation of Buprenorphine for Opioid Use Disorder: Current Status, and Future Potential

Cited by 19 publications

References 41 publications

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

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

Review article: Rapid review of the emergency department‐initiated buprenorphine for opioid use disorder

Naloxone should remain the appropriate antidote to treat opioid overdose

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