Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention

  • Gail D’Onofrio
  • Marek C. Chawarski
  • Patrick G. O’Connor
  • Michael V. Pantalon
  • Susan H. Busch
  • Patricia H. Owens
  • Kathryn Hawk
  • Steven L. Bernstein
  • David A. Fiellin
Original Research

DOI: 10.1007/s11606-017-3993-2

Cite this article as:
D’Onofrio, G., Chawarski, M.C., O’Connor, P.G. et al. J GEN INTERN MED (2017). doi:10.1007/s11606-017-3993-2

ABSTRACT

Background

Emergency department (ED)-initiated buprenorphine/naloxone with continuation in primary care was found to increase engagement in addiction treatment and reduce illicit opioid use at 30 days compared to referral only or a brief intervention with referral.

Objective

To evaluate the long-term outcomes at 2, 6 and 12 months following ED interventions.

Design

Evaluation of treatment engagement, drug use, and HIV risk among a cohort of patients from a randomized trial who completed at least one long-term follow-up assessment.

Participants

A total of 290/329 patients (88% of the randomized sample) were included. The followed cohort did not differ significantly from the randomized sample.

Interventions

ED-initiated buprenorphine with 10-week continuation in primary care, referral, or brief intervention were provided in the ED at study entry.

Main Measures

Self-reported engagement in formal addiction treatment, days of illicit opioid use, and HIV risk (2, 6, 12 months); urine toxicology (2, 6 months).

Key Results

A greater number of patients in the buprenorphine group were engaged in addiction treatment at 2 months [68/92 (74%), 95% CI 65–83] compared with referral [42/79 (53%), 95% CI 42–64] and brief intervention [39/83 (47%), 95% CI 37–58; p < 0.001]. The differences were not significant at 6 months [51/92 (55%), 95% CI 45–65; 46/70 (66%) 95% CI 54–76; 43/76 (57%) 95% CI 45–67; p = 0.37] or 12 months [42/86 (49%) 95% CI 39–59; 37/73 (51%) 95% CI 39–62; 49/78 (63%) 95% CI 52–73; p = 0.16]. At 2 months, the buprenorphine group reported fewer days of illicit opioid use [1.1 (95% CI 0.6–1.6)] versus referral [1.8 (95% CI 1.2–2.3)] and brief intervention [2.0 (95% CI 1.5–2.6), p = 0.04]. No significant differences in illicit opioid use were observed at 6 or 12 months. There were no significant differences in HIV risk or rates of opioid-negative urine results at any time.

Conclusions

ED-initiated buprenorphine was associated with increased engagement in addiction treatment and reduced illicit opioid use during the 2-month interval when buprenorphine was continued in primary care. Outcomes at 6 and 12 months were comparable across all groups.

KEY WORDS

opioid use disorder substance use disorder emergency medicine primary care 

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Gail D’Onofrio
    • 1
  • Marek C. Chawarski
    • 1
    • 2
  • Patrick G. O’Connor
    • 3
  • Michael V. Pantalon
    • 1
  • Susan H. Busch
    • 4
  • Patricia H. Owens
    • 1
  • Kathryn Hawk
    • 1
  • Steven L. Bernstein
    • 1
  • David A. Fiellin
    • 3
    • 4
  1. 1.Department of Emergency MedicineYale School of MedicineNew HavenUSA
  2. 2.Department of PsychiatryYale School of MedicineNew HavenUSA
  3. 3.Department of General MedicineYale School of MedicineNew HavenUSA
  4. 4.Yale School of Public HealthNew HavenUSA

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