Improving Outcomes for Persons with Opioid Use Disorder by Introducing Buprenorphine in the Emergency Department

BACKGROUND: Opioid related death is the leading cause of accidental death in adults younger than 50 years old in the United States (US) with approximately 130 opioid related deaths daily. Emergency department (ED) visits for a non-fatal overdose, the one-year mortality is 4.7-5.5%. Studies show increased access to medications for opioid use disorder (MOUD) decrease morbidity and mortality related to OUD. Additionally, there is evidence that initiating MOUD in the ED increases engagement in outpatient follow up, also reducing morbidity and mortality associated with OUD.

LOCAL PROBLEM: The setting for this practice improvement project was a non-profit, rural ED in North Carolina (NC) that primarily serves a Native American population. The Native American population is disproportionately affected by OUD and has the highest drug per-capita overdose death rate in the US. The project site is in a county with a significantly higher per-capita fatal overdose rate when compared to NC, with 98.1 deaths per 100,000 residents. The purpose of the project was to increase access to MOUD by offering buprenorphine in the ED as bridge to outpatient follow-up.

METHODS: The Evidence-based Practice Improvement (EBPI) model was used to guide the project using small tests of change. Planning involved a multidisciplinary approach. Patients given buprenorphine in the ED were followed at 30 and 90 days to determine if they remained engaged in the outpatient behavioral health clinic. Pre-implementation and post-implementation overdose data was also compared.

INTERVENTIONS: Two algorithms were created which used a step-by-step approach that was evaluated and approved by the project site’s head psychiatrist and medical director. An educational voice over PowerPoint was developed and distributed to all ED providers and nursing staff. Also, a physical binder was created with each algorithm, a checklist for providers and nurses, additional educational handouts, and a discharge handout for patients.

RESULTS: 1 patient was prescribed buprenorphine in the ED during the project implementation period. This patient was engaged in outpatient behavioral treatment at 30 days. The patient was given buprenorphine on 1/5/2024 and has not yet met the 90-day evaluation period to determine engagement.

CONCLUSIONS: Although there was a lower-than-expected number of participants in the project, the 1 participant was engaged in behavioral health at 30 days. When a patient remains engaged in treatment, they are less likely to use illicit drugs, reducing associated morbidity and mortality. Continued collaboration with the “Bridge Team” will focus on ways to increased access to MOUD, reducing morbidity and mortality and improving outcomes for patients affected by OUD.