ERs Can Aid in the Fight Against Opioid Addiction

According to experts, a program designed to encourage the use of a medicine that can help individuals overcome opioid addiction resulted in huge increases in its use in emergency rooms. 

Buprenorphine is an opioid withdrawal medicine that also relieves cravings. Its use can assist persons with opioid use disorder stay engaged in care while reducing overdose mortality and other drug-related problems. 

The University of Pennsylvania researchers devised the initiative to provide incentives for doctors to learn to treat opioid use disorder, as well as to develop and improve the relationship between patients and peer recovery specialists. 

The approach, which was designed to enhance the use of buprenorphine treatment for opioid use disorder in emergency rooms, was evaluated at three Penn Medicine hospitals and resulted in a sixfold increase in treatment at these locations.  


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“We used a behavioral design approach to make implementation of evidence-based treatment easy, attractive, social and timely. While we concentrated initially on prescribing itself, we realized we also needed to overcome other barriers, such as identifying and engaging patients in care,” lead study author and assistant professor of medicine Dr. Margaret Lowenstein said in a university news release. 

This drug has the potential to save patients’ lives. To make it easier for people to obtain it, researchers needed to first make it easier to prescribe by assisting more clinicians in becoming authorized prescribers.  

The physicians in the trial required an X-waiver, which required training, although those limits were later relaxed in 2021. Physicians must still register in advance on a government website in order to prescribe the medicine.  

The clinical team employed a financial incentive system that paid doctors for their participation in the training, raising their numbers from 6% to 90% in sex weeks. 

The researchers also created a system that used electronic health records to identify patients and promptly connect them with peer recovery specialists when they were in the hospital or in the early stages of recovery.  

Data for the study were collected from March 2017 to July 2020, 18 months before and after the program’s commencement date. It discovered that the proportion of patients with opioid addiction who received buprenorphine in emergency departments increased from 3% before the trial to 23% by the conclusion of the study period.  

Patients continued to use the drug and raised their dosage even a year after the adjustments were implemented, despite the fact tat not all doctors prescribed it at the same pace, according to the report. Some doctors provided buprenorphine to 61% of their opioid-addiction patients, while others never wrote a prescription, even if they were permitted.  


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“The fact that some physicians in our group were able to provide this evidence-based treatment to more than half of their patients while others had the ability to do so, but never did, showed there was much more work to be done to nudge clinicians and make offering this treatment a default process,” said senior study author Dr. M. Kit Delgado, an assistant professor of emergency medicine and epidemiology.  

Based on this information, the researchers convened a focus group of 29 emergency department doctors and nurses. They discovered that the automated procedure was not locating all eligible patients because the algorithm required additional specifically.  

“Moving forward, we’re going to test different ways to better ensure that patients we’re discharging with buprenorphine prescriptions have a warm handoff and engagement with ongoing addiction treatment. Starting this medication is the best first step, but there are many more on the long-term path to recovery once they leave the hospital,” Delgado said in the release. 


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