Initiating buprenorphine in New Jersey emergency departments: a mixed methods study

Area of Science:

• Public Health
• Addiction Medicine
• Health Services Research

Background:

• Emergency departments (EDs) are crucial for opioid use disorder (OUD) treatment.
• Evidence-based practices like buprenorphine initiation are underutilized in ED settings.

Purpose of the Study:

• To describe the state-wide adoption of buprenorphine for OUD patients in New Jersey (NJ) EDs.
• To examine clinical practices within EDs related to buprenorphine initiation.

Main Methods:

• A sequential mixed-methods approach using NJ Medicaid claims and ED leader interviews.
• Quantitative analysis of buprenorphine utilization post-ED discharge (0-4 days).
• Qualitative analysis of semi-structured interviews with ED leaders from higher and lower prescribing EDs.

Main Results:

• Buprenorphine initiation in NJ EDs peaked at 14.4% in 2022, with significant variation across facilities.
• Facilitators included peer navigator programs, community provider availability, and a positive culture towards Medication for Opioid Use Disorder (MOUD).
• Barriers included provider hesitancy, limited community resources, and regulatory issues.

Conclusions:

• Despite high patient volumes for OUD in NJ EDs, buprenorphine initiation rates remain low.
• Significant variation exists in provider and institutional capacity for buprenorphine initiation.
• Standardization of this evidence-based practice in EDs is necessary.