scispace - formally typeset
Search or ask a question
Author

Samuel I Dunham

Bio: Samuel I Dunham is an academic researcher from University of Colorado Denver. The author has contributed to research in topics: Buprenorphine & Opioid overdose. The author has an hindex of 1, co-authored 1 publications receiving 4 citations.

Papers
More filters
Journal ArticleDOI
TL;DR: A literature review summarizing the evidence for buprenorphine induction in the ED including best practices for dosing, follow-up care, and reducing implementation barriers finds uncertainty persists in how to best identify patients needing treatment, how to initiate bupenorphine, and how to enhance follow- up after ED-initiated treatment.
Abstract: ED-initiated addiction treatment holds promise for enhancing access to treatment for those with opioid use disorder (OUD). We present a literature review summarizing the evidence for buprenorphine induction in the ED including best practices for dosing, follow-up care, and reducing implementation barriers. A literature search of Pubmed, PsychInfo, and Embase identified articles studying OUD treatment in the ED published after 1980. Twenty-five studies were identified including eleven scientific abstracts. Multiple studies suggest that buprenorphine induction improves engagement in substance treatment up to 30 days after ED treatment. Many different induction protocols were presented, but no particular approach was best supported as criteria for induction and initial dosing vary widely. Similarly, transition of care models focused on either a "hub and spoke" model or "warm hand-offs" model, but no studies compared these approaches. Common barriers to implementing induction programs were provider inexperience, discomfort with addiction treatment, and limited time during the ED visit. No studies described the number of EDs offering induction. While ED buprenorphine induction is safe and enhances adherence to addiction treatment, uncertainty persists in how to best identify patients needing treatment, how to initiate buprenorphine, and how to enhance follow-up after ED-initiated treatment.

10 citations


Cited by
More filters
Journal ArticleDOI
TL;DR: In this article, the authors identify reasons for refusal of EMS transport after opioid overdose reversal, identify conditions under which overdose survivors might be more likely to accept these services, and describe solutions proposed by both PWUD and EMS providers to improve post-overdose care.

14 citations

Journal ArticleDOI
TL;DR: In this article , the authors present data from clinical studies of buprenorphine induction and propose a neuropharmacologic working model, which posits that acute clinical success is a nonlinear outcome of the opioid balance at the time of initial dose and mu-opioid-receptor affinity, lipophilicity, and intrinsic efficacy.

3 citations

Journal ArticleDOI
TL;DR: The role and use of buprenorphine in the emergency department has been discussed in this paper, where the authors provide an updated overview of the role of the drug in the ED setting.
Abstract: Introduction Opioid abuse and overdose deaths have reached epidemic proportions in the last couple decades. In response to rational prescribing initiatives, utilization of prescription opioids has decreased; however, the number of deaths due to opioid overdoses continues to rise, largely driven by fentanyl analogues in adulterated heroin. Solutions to the opioid crisis must be multifaceted and address underlying opioid addiction. In recent years, buprenorphine has become a cornerstone in the treatment of opioid use disorder (OUD) and initiation of therapy in the emergency department (ED) has become increasingly common. There have also been calls by many organizations to remove the requirement for additional training and X-waiver to prescribe buprenorphine. In April 2021, the Biden Administration eased prescribing restrictions on the drug. These initiatives are expected to increase ED utilization of the buprenorphine. The purpose of this paper is to provide an updated overview of the role and use of buprenorphine in the ED setting so physicians may adapt to the changing practice environment. Objectives This is a narrative review describing the role of buprenorphine in the ED. A PubMed search was conducted using the keywords “opioid epidemic” “buprenorphine,” and “medication assisted therapy”, and “emergency department”. All the articles that contained information on the opioid epidemic, medication assisted therapy, and the biological effects of buprenorphine, that were also relevant to pain management and the ED, were included in the review. Discussion Multiple studies have pointed to the effective use of buprenorphine as a treatment for OUDs in ED patients and are superior to standard care; however, there are various barriers to its use in the ED setting. Conclusion Emergency physicians can influence opioid related morbidity and mortality, by familiarizing themselves with the use of buprenorphine to treat opioid withdrawal and addiction, particularly now that prescribing restrictions have been eased. Further ED research is necessary to assess the optimal use of buprenorphine in this care setting.

3 citations

Journal ArticleDOI
27 Sep 2021-BMJ Open
TL;DR: A comprehensive review and critical analysis of both facilitators of and barriers to buprenorphine initiation in ED has yet to be published as mentioned in this paper, however, this review does not require ethics approval and is based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols Extension for Scoping Reviews.
Abstract: Introduction Buprenorphine-naloxone is recommended as a first-line agent for the treatment of opioid use disorder. Although initiation of buprenorphine in the emergency department (ED) is evidence based, barriers to implementation persist. A comprehensive review and critical analysis of both facilitators of and barriers to buprenorphine initiation in ED has yet to be published. Our objectives are (1) to map the implementation of buprenorphine induction pathway literature and synthesise what we know about buprenorphine pathways in EDs and (2) to identify gaps in this literature with respect to barriers and facilitators of implementation. Methods and analysis We will conduct a scoping review to comprehensively search the literature, map the evidence and identify gaps in knowledge. The review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols Extension for Scoping Reviews and guidance from the Joanna Briggs Institution for conduct of scoping reviews. We will search Medline, APA, PsycINFO, CINAHL, Embase and IBSS from 1995 to present and the search will be restricted to English and French language publications. Citations will be screened in Covidence by two trained reviewers. Discrepancies will be mediated by consensus. Data will be synthesised using a hybrid, inductive-deductive approach, informed by the Consolidated Framework for Implementation Research as well as critical theory to guide further interpretation. Ethics and dissemination This review does not require ethics approval. A group of primary knowledge users, including clinicians and people with lived experience, will be involved in the dissemination of findings including publication in peer-reviewed journals. Results will inform future research, current quality improvement efforts in affiliated hospitals, and aide the creation of a more robust ED response to the escalating overdose crisis.

1 citations