Extended-release Buprenorphine for Opioid Use Disorder in Hospital and Emergency Department Settings

Hospitalization and emergency department (ED) visits are an underutilized opportunity to reach high-risk patients with opioid use disorder (OUD) with buprenorphine (BUP) treatment and reduce the ongoing and widespread treatment gap. Monthly extended-release BUP (XR-BUP) potentially facilitates successful initiation and delivers sustained treatment. XR-BUP provides up to 30 days of medication for opioid use disorder (MOUD) with each administration and could improve retention in care during transition to outpatient addiction treatment. We aim to describe the patient characteristics and clinical outcomes of hospitalized and ED patients with OUD treated with monthly XR-BUP.

We conducted a retrospective chart review of a cohort of ED or hospitalized patients who received monthly XR-BUP at an urban, safety-net hospital over a 6-month period from September 2023 through March 2024.

There were 61 patient encounters where XR-BUP was administered. Within 30 days of discharge, 40/61 (65.6%) patients who received XR-BUP engaged in outpatient addiction treatment through an in-person or telemedicine provider visit; within 45 days, 29/61 (47.5%) patients received a subsequent XR-BUP. Thirty-eight (62.3%) initiated XR-BUP with low-dose initiation of sublingual buprenorphine with full agonist opioid continuation, 20 (32.8%) started after high-dose sublingual buprenorphine, 2 (3.3%) after low-dose initiation of IV buprenorphine, and 1 (1.6%) received "direct to inject" XR-BUP.

In this observational retrospective study, rates of engagement in addiction treatment after discharge among patients with OUD receiving XR-BUP were high. Clinical teams utilized novel strategies to initiate XR-BUP during ED and hospital-based encounters.