Rapid Adoption of Low-Threshold Buprenorphine Treatment at California Emergency Departments Participating in the CA Bridge Program

User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial

“…Because the use of EMBED required clinicians to identify patients who would benefit from buprenorphine, future research could study a targeted, non-interruptive alert for patients in the emergency department who are eligible for buprenorphine as well as more granular analysis of the effectiveness of individual components of the intervention or the effect of the intervention on patient safety outcomes. Given our findings, the recent literature on barriers to implementation,1150 the role of comprehensive buprenorphine programs in the emergency department,5253 and new changes in the requirements for waiver training,58 future research could also study the effect of EMBED combined with other implementation facilitators to assess whether EMBED could contribute to increased rates of initiating buprenorphine in the emergency department, engagement with treatment, and other downstream outcomes for patients with opioid use disorder.…”

“…Initiating buprenorphine in the emergency department is a process that requires multiple actions at the patient, clinician, and healthcare system levels before, during, and after the visit to the emergency department 50. Comprehensive programs for opioid use disorder in the emergency department have achieved high rates of initiation of buprenorphine and engagement in outpatient follow-up; a program in South Carolina reported a buprenorphine rate in the emergency department of 45.4% in 509 patients, and a program in California reported a rate of 59.7% in 12 009 patients 5253. Although these multifaceted programs confirm that initiating buprenorphine in the emergency department is feasible, they included dedicated funding, staff, and hospital based outpatient resources.…”

Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program

“…7 Recognizing this opportunity, over the past decade, EDs across the U.S. began providing take-home naloxone, behavioral counseling, and medication for opioid use disorder (MOUD), specifically buprenorphine. [8][9][10][11][12][13][14][15][16][17][18][19] Although these interventions have been shown to be feasible in ED settings, uptake has been slow and unevenly distributed. [20][21][22][23][24][25] There are multiple ongoing efforts to improve the quality of post-overdose ED care and dissemination of ED take-home naloxone, behavioral counseling, and treatment initiation through local, state, and national initiatives.…”

“…[20][21][22][23][24][25] There are multiple ongoing efforts to improve the quality of post-overdose ED care and dissemination of ED take-home naloxone, behavioral counseling, and treatment initiation through local, state, and national initiatives. 16,17,19,22,[26][27][28] However, there is limited knowledge about maintenance of post-overdose services provision and implementation moderators, specifically patient, clinician, and institutional factors influencing access to and acceptance of takehome naloxone, behavioral counseling, and referral to treatment.…”

“…Among an otherwise young and healthy patient population, an overdose‐related ED visit may be the only encounter a person with opioid use disorder (OUD) and/or people at risk for opioid overdose have with the healthcare system, and therefore represents a key opportunity to provide patients life‐saving harm reduction services and addiction treatment 7 . Recognizing this opportunity, over the past decade, EDs across the U.S. began providing take‐home naloxone, behavioral counseling, and medication for opioid use disorder (MOUD), specifically buprenorphine 8–19 . Although these interventions have been shown to be feasible in ED settings, uptake has been slow and unevenly distributed 20–25 …”