The Opioid Crisis, Centers for Disease Control Opioid Guideline, and Naloxone Coprescription for Patients at Risk for Opioid Overdose

Benzon, Honorio T.; Sun, Eric; Chou, Roger

doi:10.1213/ane.0000000000006029

Cited by 1 publication

(2 citation statements)

References 23 publications

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“…Opioid use disorder (OUD) is a major public health problem affecting an estimated 2 million Americans . Opioid overdose rates are also increasing, with an estimate of a 4.0% quarterly increase in nonfatal opioid overdoses from 2018 to 2022 .…”

Section: Introductionmentioning

confidence: 99%

“…Opioid use disorder (OUD) is a major public health problem affecting an estimated 2 million Americans. 1 , 2 Opioid overdose rates are also increasing, with an estimate of a 4.0% quarterly increase in nonfatal opioid overdoses from 2018 to 2022. 3 , 4 With 2.88 million opioid-related emergency department (ED) visits in 2016 and evidence showing continued rate increases, the ED is increasingly viewed as a front-line setting for initiating OUD treatment, such as buprenorphine-naloxone, during a critical period at which patients are at high risk for future overdoses.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adoption of Emergency Department–Initiated Buprenorphine for Patients With Opioid Use Disorder

Gao,

Melnick,

Paek

et al. 2023

JAMA Netw Open

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ImportanceEmergency department (ED) initiation of buprenorphine is safe and effective but underutilized in practice. Understanding the factors affecting adoption of this practice could inform more effective interventions.ObjectiveTo quantify the factors, including social contagion, associated with the adoption of the practice of ED initiation of buprenorphine for patients with opioid use disorder.Design, Setting, and ParticipantsThis is a secondary analysis of the EMBED (Emergency Department-Initiated Buprenorphine For Opioid Use Disorder) trial, a multicentered, cluster randomized trial of a clinical decision support intervention targeting ED initiation of buprenorphine. The trial occurred from November 2019 to May 2021. The study was conducted at ED clusters across health care systems from the northeast, southeast, and western regions of the US and included attending physicians, resident physicians, and advanced practice practitioners. Data analysis was performed from August 2022 to June 2023.ExposuresThis analysis included both the intervention and nonintervention groups of the EMBED trial. Graph methods were used to construct the network of clinicians who shared in the care of patients for whom buprenorphine was initiated during the trial before initiating the practice themselves, termed exposure.Main Outcomes and MeasuresCox proportional hazard modeling with time-dependent covariates was performed to assess the association of the number of these exposures with self-adoption of the practice of ED initiation of buprenorphine while adjusting for clinician role, health care system, and intervention site status.ResultsA total of 1026 unique clinicians in 18 ED clusters across 5 health care systems were included. Analysis showed associations of the cumulative number of exposures to others initiating buprenorphine with the self-practice of buprenorphine initiation. This increased in a dose-dependent manner (1 exposure: hazard ratio [HR], 1.31; 95% CI, 1.16-1.48; 5 exposures: HR, 2.85; 95% CI, 1.66-4.89; 10 exposures: HR, 3.55; 95% CI, 1.47-8.58). Intervention site status was associated with practice adoption (HR, 1.50; 95% CI, 1.04-2.18). Health care system and clinician role were also associated with practice adoption.Conclusions and RelevanceIn this secondary analysis of a multicenter, cluster randomized trial of a clinical decision support tool for buprenorphine initiation, the number of exposures to ED initiation of buprenorphine and the trial intervention were associated with uptake of ED initiation of buprenorphine. Although systems-level approaches are necessary to increase the rate of buprenorphine initiation, individual clinicians may change practice of those around them.Trial RegistrationClinicalTrials.gov Identifier: NCT03658642

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Section: Introductionmentioning

confidence: 99%