Promoting Provider Readiness to Induce Buprenorphine for Treatment of Opioid Use Disorder Within the Emergency Department

Background: Opioid-involved deaths in the United States have risen steadily since 2018, from 47,000 to 69,000 deaths. Furthermore, from 2020 to 2021, opioid overdose fatalities increased by 35%. Despite ample evidence that buprenorphine is safer and more efficacious than more commonly used alpha-2 agonists, emergency medicine providers (EMPs) are disinclined to induce buprenorphine in the emergency department. Preferential use of alpha-2 agonists negatively impacts health outcomes, including engagement in treatment and mortality rates. Methods: Questionnaires ascertaining baseline readiness and identifying perceived barriers to inducing buprenorphine were developed and distributed to a physician group of EMPs staffing emergency departments in six major teaching hospitals across northern Utah. A buprenorphine educational module and buprenorphine prescriber toolkit were developed and disseminated to EMPs in the physician group. The educational module included buprenorphine efficacy and safety data and content addressing commonly perceived barriers to buprenorphine induction. The prescriber toolkit included protocols related to dosing, administration, patient monitoring, and management of withdrawal symptoms post-buprenorphine induction. Post-education and post- implementation questionnaires were sent to EMPs to determine intervention efficacy. Results: The intervention affected 100 percent of EMPs' (n=8) readiness to prescribe buprenorphine, and 75% (n=6) reported they anticipated prescribing buprenorphine more frequently in emergency department settings. Conclusions: This quality improvement project has triggered an ongoing improvement initiative necessary for continued study, development, and implementation of buprenorphine safe practices. Small sample size considered, the buprenorphine educational module and buprenorphine prescriber tool kit improved EMPs' readiness to induce buprenorphine in treating opioid use disorder in emergency clinic settings. Replicating this project with increased participation and reduced attrition will establish the validity and generalizability of project finding.