Initiation of extended-release buprenorphine in emergency department patients: A retrospective cohort study

To determine the outcomes of emergency department (ED) patients with opioid use disorder (OUD) who were treated with high dose sublingual and subcutaneous buprenorphine and admitted to an inpatient withdrawal management unit (WiMU).

We conducted a retrospective chart review of patients with OUD who presented to the ED of the Timmins and District Hospital (TADH) and who had received high (minimum 16 mg, no upper bound) dose sublingual buprenorphine (SL bup), administration of 300 mg injectable extended-release buprenorphine (ER bup), and admission to the WiMu.

Ninety patients met the inclusion criteria: the majority were fentanyl users (98 %) and Indigenous (61 %). There were no adverse events, including precipitated withdrawal, as a result of receiving high dose SL bup and ER bup. Treatment retention at 3, 6, and 12 months was 58 %, 44 %, and 36 % respectively. In the year following treatment initiation, there was a reduction in non-fatal overdoses (21.9 %, p = 0.0018), ED visits (78.1 %, p < 0.0001), and hospitalizations (77.1 %, p < 0.0001) compared to the year prior to treatment initiation.

In patients with OUD presenting to a community ED, a treatment regimen of high dose SL bup and ER bup, and admission to a designated unit resulted in significantly reduced nonfatal overdoses, ED visits, and hospitalizations at one year.