Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions.
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TLDR
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.read more
Citations
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Refusal to accept emergency medical transport following opioid overdose, and conditions that may promote connections to care.
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A Neuropharmacological Model to Explain Buprenorphine Induction Challenges.
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.
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A practical review of buprenorphine utilization for the emergency physician in the era of decreased prescribing restrictions.
Ali Pourmand,Kamilla Beisenova,Nebiyu Shukur,Collin Tebo,Nakita Mortimer,Maryann Mazer-Amirshahi +5 more
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.
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Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department
Gideon Logan,Amber Mirajkar,Jessica Houck,Fernando Rivera-Alvarez,Emily Drone,Parth Patel,Alexandra Craen,L. Dub,N. Elahi,David Lebowitz,Ayanna Walker,Latha Ganti +11 more
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Facilitators of and barriers to buprenorphine initiation for people with opioid use disorder in the emergency department: protocol for a scoping review.
Nikki Bozinoff,Nikki Bozinoff,Charlene Soobiah,Terri Rodak,Christine Bucago,Katie Kingston,Michelle Klaiman,Brittany A. Poynter,Glenna Samuels,Elizabeth M. Schoenfeld,Dominick Shelton,Csilla Kalocsai,Csilla Kalocsai +12 more
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.
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