scispace - formally typeset
Journal ArticleDOI: 10.1080/10903127.2020.1747579

Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series.

04 Mar 2021-Prehospital Emergency Care (Informa UK Limited)-Vol. 25, Iss: 2, pp 289-293
Abstract: The opioid epidemic is currently a leading health crisis in the United States, and evidence supports Medication for Opioid Use Disorder (MOUD) as the most effective treatment (2). In our EMS system...

... read more

Topics: Buprenorphine (58%), Opioid use disorder (57%), Emergency medical services (53%) ... read more
Citations
  More

12 results found


Journal ArticleDOI: 10.31478/202004B
27 Apr 2020-
Abstract: | Even though evidence-based treatment for opioid use disorders (OUD) is eff ective, almost four in fi ve Americans with OUD do not receive any form of treatment. The gap in access to evidencebased care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. This paper includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and fi nancial barriers. Action from a number of actors is urgently needed to address this crisis.

... read more

Topics: Opioid use disorder (55%)

32 Citations


Open accessJournal ArticleDOI: 10.2147/OAEM.S267416
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.

... read more

Topics: Buprenorphine (62%), Opioid use disorder (60%), Opioid overdose (58%)

4 Citations


Journal ArticleDOI: 10.1016/J.ANNEMERGMED.2021.01.017
Abstract: Treatment with buprenorphine significantly reduces both all-cause and overdose mortality among individuals with opioid use disorder Offering buprenorphine treatment to individuals who experience a nonfatal opioid overdose represents an opportunity to reduce opioid overdose fatalities Although some emergency departments (EDs) initiate buprenorphine treatment, many individuals who experience an overdose either refuse transport to the ED or are transported to an ED that does not offer buprenorphine Emergency medical services (EMS) professionals can help address this treatment gap In this Concepts article, we describe the federal legal landscape that governs the ability of EMS professionals to administer buprenorphine treatment, and discuss state and local regulatory considerations relevant to this promising and emerging practice

... read more

Topics: Opioid overdose (68%), Buprenorphine (64%), Opioid use disorder (60%) ... read more

2 Citations


Journal ArticleDOI: 10.1080/10903127.2021.1884324
Abstract: Objective: U.S. opioid overdoses increased nearly sixfold from 1999 to 2018, and greater than 1% of all emergency medical services (EMS) encounters now involve naloxone administration. While “treat...

... read more

Topics: Naloxone (68%), Drug overdose (63%), Opioid (54%)

2 Citations



References
  More

12 results found


Open accessJournal ArticleDOI: 10.1001/JAMA.2015.3474
28 Apr 2015-JAMA
Abstract: RESULTS Seventy-eight percent of patients in the buprenorphine group (89 of 114 [95% CI, 70%-85%]) vs 37% in the referral group (38 of 102 [95% CI, 28%-47%]) and 45% in the brief intervention group (50 of 111 [95% CI, 36%-54%]) were engaged in addiction treatment on the 30th day after randomization (P < .001). The buprenorphine group reduced the number of days of illicit opioid use per week from 5.4 days (95% CI, 5.1-5.7) to 0.9 days (95% CI, 0.5-1.3) vs a reduction from 5.4 days (95% CI, 5.1-5.7) to 2.3 days (95% CI, 1.7-3.0) in the referral group and from 5.6 days (95% CI, 5.3-5.9) to 2.4 days (95% CI, 1.8-3.0) in the brief intervention group (P < .001 for both time and intervention effects; P = .02 for the interaction effect). The rates of urine samples that tested negative for opioids did not differ statistically across groups, with 53.8% (95% CI, 42%-65%) in the referral group, 42.9% (95% CI, 31%-55%) in the brief intervention group, and 57.6% (95% CI, 47%-68%) in the buprenorphine group (P = .17). There were no statistically significant differences in HIV risk across groups (P = .66). Eleven percent of patients in the buprenorphine group (95% CI, 6%-19%) used inpatient addiction treatment services, whereas 37% in the referral group (95% CI, 27%-48%) and 35% in the brief intervention group (95% CI, 25%-37%) used inpatient addiction treatment services (P < .001).

... read more

Topics: Buprenorphine (50%)

455 Citations


Open accessJournal ArticleDOI: 10.7326/M17-3107
Marc R. Larochelle1, Dana Bernson2, Thomas Land2, Thomas J. Stopka3  +5 moreInstitutions (4)
Abstract: Background Opioid overdose survivors have an increased risk for death. Whether use of medications for opioid use disorder (MOUD) after overdose is associated with mortality is not known. Objective To identify MOUD use after opioid overdose and its association with all-cause and opioid-related mortality. Design Retrospective cohort study. Setting 7 individually linked data sets from Massachusetts government agencies. Participants 17 568 Massachusetts adults without cancer who survived an opioid overdose between 2012 and 2014. Measurements Three types of MOUD were examined: methadone maintenance treatment (MMT), buprenorphine, and naltrexone. Exposure to MOUD was identified at monthly intervals, and persons were considered exposed through the month after last receipt. A multivariable Cox proportional hazards model was used to examine MOUD as a monthly time-varying exposure variable to predict time to all-cause and opioid-related mortality. Results In the 12 months after a nonfatal overdose, 2040 persons (11%) enrolled in MMT for a median of 5 months (interquartile range, 2 to 9 months), 3022 persons (17%) received buprenorphine for a median of 4 months (interquartile range, 2 to 8 months), and 1099 persons (6%) received naltrexone for a median of 1 month (interquartile range, 1 to 2 months). Among the entire cohort, all-cause mortality was 4.7 deaths (95% CI, 4.4 to 5.0 deaths) per 100 person-years and opioid-related mortality was 2.1 deaths (CI, 1.9 to 2.4 deaths) per 100 person-years. Compared with no MOUD, MMT was associated with decreased all-cause mortality (adjusted hazard ratio [AHR], 0.47 [CI, 0.32 to 0.71]) and opioid-related mortality (AHR, 0.41 [CI, 0.24 to 0.70]). Buprenorphine was associated with decreased all-cause mortality (AHR, 0.63 [CI, 0.46 to 0.87]) and opioid-related mortality (AHR, 0.62 [CI, 0.41 to 0.92]). No associations between naltrexone and all-cause mortality (AHR, 1.44 [CI, 0.84 to 2.46]) or opioid-related mortality (AHR, 1.42 [CI, 0.73 to 2.79]) were identified. Limitation Few events among naltrexone recipients preclude confident conclusions. Conclusion A minority of opioid overdose survivors received MOUD. Buprenorphine and MMT were associated with reduced all-cause and opioid-related mortality. Primary funding source National Center for Advancing Translational Sciences of the National Institutes of Health.

... read more

Topics: Opioid overdose (59%), Buprenorphine (55%), Naltrexone (55%) ... read more

352 Citations


Open accessJournal Article
Abstract: Patients who survive an opioid overdose are at increased risk for subsequent nonfatal and fatal events. This study evaluated overdose survivors to determine whether use of medications for opioid us...

... read more

Topics: Opioid overdose (74%), Opioid use disorder (58%), Opioid (50%)

272 Citations


Journal ArticleDOI: 10.1016/S0376-8716(03)00056-5
Sharon L. Walsh1, Thomas Eissenberg2Institutions (2)
Abstract: This paper will review clinical pharmacology studies on buprenorphine, a mixed opioid agonist-antagonist currently approved as a treatment for opioid dependence. The focus is on studies characterizing buprenorphine's pharmacodynamic actions, including its safety, abuse liability, withdrawal suppression and withdrawal precipitation capacity, physical dependence potential, cross-tolerance and duration of action as well as a review of the pharmacological profile of buprenorphine/naloxone combinations. The findings from these clinical pharmacology studies are synthesized and presented in a framework designed to (1) inform clinicians about the advantages and disadvantages of buprenorphine as an opioid maintenance agent, and (2) provide information about dosing procedures that may optimize the use of buprenorphine in the clinic.

... read more

Topics: Buprenorphine (65%), Clinical pharmacology (55%), Naloxone (53%)

184 Citations


Open accessJournal ArticleDOI: 10.1001/JAMANETWORKOPEN.2019.20622
05 Feb 2020-
Abstract: Importance Although clinical trials demonstrate the superior effectiveness of medication for opioid use disorder (MOUD) compared with nonpharmacologic treatment, national data on the comparative effectiveness of real-world treatment pathways are lacking. Objective To examine associations between opioid use disorder (OUD) treatment pathways and overdose and opioid-related acute care use as proxies for OUD recurrence. Design, Setting, and Participants This retrospective comparative effectiveness research study assessed deidentified claims from the OptumLabs Data Warehouse from individuals aged 16 years or older with OUD and commercial or Medicare Advantage coverage. Opioid use disorder was identified based on 1 or more inpatient or 2 or more outpatient claims for OUD diagnosis codes within 3 months of each other; 1 or more claims for OUD plus diagnosis codes for opioid-related overdose, injection-related infection, or inpatient detoxification or residential services; or MOUD claims between January 1, 2015, and September 30, 2017. Data analysis was performed from April 1, 2018, to June 30, 2019. Exposures One of 6 mutually exclusive treatment pathways, including (1) no treatment, (2) inpatient detoxification or residential services, (3) intensive behavioral health, (4) buprenorphine or methadone, (5) naltrexone, and (6) nonintensive behavioral health. Main Outcomes and Measures Opioid-related overdose or serious acute care use during 3 and 12 months after initial treatment. Results A total of 40 885 individuals with OUD (mean [SD] age, 47.73 [17.25] years; 22 172 [54.2%] male; 30 332 [74.2%] white) were identified. For OUD treatment, 24 258 (59.3%) received nonintensive behavioral health, 6455 (15.8%) received inpatient detoxification or residential services, 5123 (12.5%) received MOUD treatment with buprenorphine or methadone, 1970 (4.8%) received intensive behavioral health, and 963 (2.4%) received MOUD treatment with naltrexone. During 3-month follow-up, 707 participants (1.7%) experienced an overdose, and 773 (1.9%) had serious opioid-related acute care use. Only treatment with buprenorphine or methadone was associated with a reduced risk of overdose during 3-month (adjusted hazard ratio [AHR], 0.24; 95% CI, 0.14-0.41) and 12-month (AHR, 0.41; 95% CI, 0.31-0.55) follow-up. Treatment with buprenorphine or methadone was also associated with reduction in serious opioid-related acute care use during 3-month (AHR, 0.68; 95% CI, 0.47-0.99) and 12-month (AHR, 0.74; 95% CI, 0.58-0.95) follow-up. Conclusions and Relevance Treatment with buprenorphine or methadone was associated with reductions in overdose and serious opioid-related acute care use compared with other treatments. Strategies to address the underuse of MOUD are needed.

... read more

Topics: Buprenorphine (58%), Methadone (57%), Opioid use disorder (56%) ... read more

152 Citations


Performance
Metrics
No. of citations received by the Paper in previous years
YearCitations
20221
20219
20202