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Area of Science:

  • Addiction Medicine
  • Pharmacology
  • Public Health

Background:

  • Extended-release buprenorphine (XR-BUP) is an injectable medication for opioid use disorder (OUD).
  • Current guidelines require prior sublingual buprenorphine (SL-BUP) treatment before XR-BUP initiation.
  • Emergency departments (EDs) are critical access points for unstable OUD patients needing medication for OUD (MOUD).

Purpose of the Study:

  • To evaluate the utility of on-demand XR-BUP administration in the ED setting.
  • To assess treatment retention and continuation rates for patients receiving initial XR-BUP in the ED.
  • To identify reasons for initiating XR-BUP in the ED versus a clinic setting.

Main Methods:

  • Retrospective cohort study of 69 OUD patients receiving XR-BUP in the ED.
  • Chart review of patients from an addiction medicine outpatient clinic.
  • Primary outcome: Retention in treatment (measured by subsequent XR-BUP injections).
  • Secondary outcome: Reasons for ED administration of XR-BUP.

Main Results:

  • High retention rates: 73.9% received a second XR-BUP injection, 58% received a third.
  • Most ED XR-BUP initiations (69.6%) were due to OUD treatment instability.
  • Patients with co-occurring substance use disorders showed higher follow-up treatment rates.

Conclusions:

  • ED-initiated XR-BUP demonstrates strong patient retention, surpassing rates for ED-initiated SL-BUP.
  • The ED serves as a crucial and convenient point for initiating XR-BUP treatment.
  • XR-BUP is effective for induction after failed SL-BUP and can minimize treatment gaps.