Emergency Department-Initiated Buprenorphine for Opioid Use Disorder: A Randomized Clinical Trial

Area of Science:

• Addiction Medicine
• Pharmacology
• Public Health

Background:

• Opioid use disorder (OUD) is a major public health crisis.
• Emergency departments (EDs) are critical touchpoints for initiating OUD treatment.
• Extended-release injectable buprenorphine offers a potential strategy for hard-to-reach populations.

Purpose of the Study:

• To compare the effectiveness of ED-initiated 7-day extended-release injectable buprenorphine versus sublingual buprenorphine.
• To assess treatment engagement at 7 days as the primary outcome.
• To evaluate secondary outcomes including 30-day engagement, withdrawal, craving, illicit use, and satisfaction.

Main Methods:

• Multicenter randomized clinical trial involving 2000 adult patients with OUD presenting to EDs.
• Patients received either 24-mg extended-release injectable buprenorphine or 7-day sublingual buprenorphine.
• Treatment engagement, withdrawal, craving, illicit use, and satisfaction were assessed.

Main Results:

• No significant difference in 7-day treatment engagement between extended-release (40.5%) and sublingual (38.5%) buprenorphine groups.
• Similar 30-day engagement rates were observed (43.8% vs 44.9%).
• Extended-release buprenorphine group reported lower craving scores and fewer days of illicit opioid use.

Conclusions:

• ED-initiated 7-day extended-release injectable buprenorphine is non-inferior to sublingual buprenorphine for initial OUD treatment engagement.
• Both formulations are well-tolerated and safe, with low rates of precipitated withdrawal.
• Extended-release injectable buprenorphine may offer advantages in reducing craving and illicit opioid use.