The Treatment of Opioid Addiction in the ED: Suboxone Education Module to Improve Perceptions and Attitudes Towards Opioid Addiction

Background. Opioids killed over 42,000 individuals in 2016. In Utah alone, 23 individuals die each month from overdose. To combat the opioid crisis, the Comprehensive Addiction and Recovery Act was signed into law, which created coordinated and balanced strategies for communities. However, more intervention and focus are needed for those already struggling with opioid addiction. The prescription drug Suboxone is seen as an ideal treatment option due to its pharmacologic properties and well known safety profile. However, there are still barriers and hesitations to clinician buy-in for Suboxone from negative perceptions and stigma, lack of opioid dependency training in the primary care setting, and belief that patients will abuse Suboxone and sell the drug on the streets. Purpose: The purpose of this quality improvement project was to educate clinicians in the emergency department about the use of Suboxone among patients with opioid addiction before integrating its use in the emergency department. This project was developed with the Emergency Department-Initiated Suboxone Program and was created to improve clinician preparation and thus improve access for patients with opioid use disorder. Methods. The project was implemented in one of the emergency departments in Salt Lake County. The module was developed after an extensive review of literature as well as existing Emergency Department-Initiated Suboxone Programs nationwide. An education module on Suboxone versus Methadone and the benefits of Suboxone initiation in the ED for opioid addiction was developed. The impact of the Suboxone Education Module was evaluated on staff perceptions with pre- and post-survey questions as well as a one month post education survey. Descriptive statistics was used to examine participants demographic data. Pre- and post-survey quantitative data was analyzed using a paired t-test. The one month follow up survey was analyzed using content analysis. Results. Registered nurses (RN) (n= 29) participated in a 30-minute Suboxone Education Module, and 12 RN's completed both pre- and post-surveys which examined knowledge and attitudes towards Emergency Department-Initiated Suboxone. One hundred percent of those attending the Suboxone Education Module stated it was helpful to their professional practice. Out of the completed one month post education surveys, 85.7 percent supported Suboxone use in the emergency department with a 72-hour Bridge Clinic follow up. A two-tailed paired t test compared the total pre- versus total post-survey scores from the six Likert scale survey questions which focused on knowledge and attitudes towards Suboxone use in the Emergency Department and showed a statistically significant difference between the two survey groups (p>0.0008). Conclusion. Results of the project provide an indication that the Suboxone Education Module improved knowledge, attitudes, and perceptions toward opioid use disorder treatment in the emergency department. Improvement in overall perceptions towards Suboxone use in the emergency department can help expand opioid treatment solutions and improve positive outcomes. A chart review of Suboxone prescriptions before and after implementation of the education module can be a future recommendation of this project.