Physician-initiated buprenorphine treatment for opioid use disorder in Nevada emergency departments
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Authors
Ajumobi, Olufemi
Issue Date
2023
Type
Dissertation
Language
Keywords
Buprenorphine , Concerns , Emergency departments , Emergency physicians , Intention , Persons with Opioid use disorder
Alternative Title
Abstract
The United States is still in the middle of the opioid overdose crisis. In 2022, over 75,000 Americans died from opioid overdoses. Evidence-based treatments for treating opioid use disorder (OUD) are available to reduce illicit opioid use and the risk of opioid overdose deaths. Buprenorphine, a prescription medication to treat OUD, can be initiated same day a patient is diagnosed with OUD without the need for opioid abstinence. But it remains underused in the outpatient setting because of regulatory and provider-level barriers. Moreover, buprenorphine has the potential for routine use in the emergency departments (EDs) where over 30% of nonfatal overdose patients seek care but is also underutilized due to those barriers. This dissertation assessed the degree of buprenorphine access in the ED, providers’ perspectives about their willingness to participate in ED buprenorphine prescribing and provider-level factors associated with the intention to prescribe buprenorphine at Nevada EDs. Paper 1 quantified the frequency of buprenorphine use following ED visits in patients with OUD diagnosis and associations with sociodemographic characteristics. The results indicated age and racial disparities in filling ED buprenorphine prescriptions at the pharmacy post-ED visits. Paper 2 documented (1) emergency physicians’ concerns about the buprenorphine program, such as information gaps in prescribing protocols, patient outcomes, buprenorphine effectiveness, and physicians’ perceived incompetence in managing opioid withdrawal, (2) mapped potential implementation strategies to these concerns. This paper revealed, improved provider education through trainings, mentorship, and human resource support has the potential to increase the participation of emergency physicians in buprenorphine programs. Paper 3 investigated factors influencing emergency physicians’ intention to prescribe buprenorphine. The results indicated that provider-based stigma was negatively associated with the intention to prescribe buprenorphine. This finding underscores the need for stigma reduction among emergency physicians. Collectively, the findings of these papers emphasized that if barriers to providing equitable treatment to persons with OUD must be overcome, informational, educational, and human resource support to emergency physicians are urgently required to maximize the opportunity for initiating persons with OUD into treatment in the EDs as buprenorphine program gradually becomes routinized in Nevada and the entire United States.