Following the expansion of a statewide program, the rate of California patients receiving their first buprenorphine prescription from an emergency room clinician increased from 0.1% in 2017 to 5% in 2022, according to a study issued this week in JAMA.
There is robust evidence supporting the use of buprenorphine and other medications for opioid use disorder (OUD), but many patients with OUD do not receive this treatment, wrote Annette M. Dekker, M.D., M.S., of the University of California, Los Angeles, and colleagues. In California, the CA Bridge program has encouraged buprenorphine initiation in the emergency department (ED) since 2019.
“Bridge has worked with more than 80% of California’s 331 acute care hospitals to establish the ED as a low-threshold point of treatment entry and support,” the authors wrote. “This has included training emergency clinicians and staff on the provision of buprenorphine for OUD and hiring of patient navigators to engage patients and connect them to community addiction treatment programs for continuation of buprenorphine.”
Dekker and colleagues used a database of Schedule II to V controlled substance prescriptions dispensed in California to identify all buprenorphine prescriptions for patients with OUD written between 2017 and 2022.
Emergency clinicians accounted for just 2% of all buprenorphine prescribers in 2017, but by 2022 they accounted for 16% of all prescribers. Further, emergency clinicians who prescribed buprenorphine for the first time increased from 70 in 2017 to 941 in 2022. Among individuals who initiated buprenorphine in the ED, one in three went on to receive a second prescription within 40 days. Finally, for every nine patients who had buprenorphine initiated by an emergency clinician, one patient achieved 180 days or more of continuous prescriptions within one year.
The study shows that, with adequate state investments, EDs can play a crucial role in connecting patients with OUD to life-saving treatment, even if it’s not always clear where patients can go to follow up, wrote Gail D’Onofrio, M.D., M.S., of the Yale School of Medicine, and colleagues in an accompanying commentary. “Challenges to treatment access are frequently insurmountable during the chaos of addiction,” they wrote. “Thus, prompt ED buprenorphine initiation has value even if follow-up is tenuous.”
For related information, see the Psychiatric News articles “Trauma Lingers in Prescribing Practices for Buprenorphine” and “Congress Removes X-Waiver Requirement.”
(Image: Getty Images/iStock/SDI Productions)
Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.