Implementation facilitation improves readiness for emergency department-initiated buprenorphine to treat opioid use disorder
Recommended Citation
Strout T, Dziura J, Barrett TW, Cowan E, Hawk KF, Herring AA, Manteuffel J, Martel S, Owens PH, McCormack RP, Perrone J, Fiellin DA, D'Onofrio G, and Edelman EJ. Implementation facilitation improves readiness for emergency department-initiated buprenorphine to treat opioid use disorder. J Subst Use Addict Treat 2025;209845.
Document Type
Article
Publication Date
12-5-2025
Publication Title
J Subst Use Addict Treat
Keywords
Buprenorphine; Emergency service; Hospital; Implementation science; Opioid; Opioid use disorder; Opioid-related disorders
Abstract
INTRODUCTION: Treatment of opioid use disorder (OUD) with buprenorphine is safe and effective, but Emergency Department-initiated buprenorphine (ED BUP) uptake is suboptimal. As part of a randomized clinical trial (RCT), we evaluated Implementation Facilitation (IF)'s impact on EDs' readiness to provide ED BUP.
METHODS: From February 2020 to May 2024, we surveyed 31 ED Medical Directors (MDs) and site-Principal Investigators (PIs) across 33 Emergency Department-INitiated bupreNOrphine VAlidaTION (ED-INNOVATION) sites (29 of which proceeded to RCT enrollment) at three time points: pre-IF (baseline), early-IF (pre-enrollment), and late-IF (post-enrollment). We collected 10-point Likert scale ratings and performed linear regression modeling and correlation analysis to evaluate relationships between readiness, barriers, facilitators, and readiness changes over time.
RESULTS: Across 31 responses for the three time points, mean readiness increased pre-IF to early-IF (6.29 vs. 8.23, p < 0.0001) and pre-IF to late-IF (6.29 vs. 8.39, p < 0.0001). We observed decreases in 13/15 barriers and increases in 13/19 facilitators. When examining relationships between changes in readiness, barriers, and facilitators, the strongest relationships were follow-up treatment availability (r = 0.64, p = 0.0001), prescribing practices knowledge (r = -0.64, p = 0.001); insurance coverage (r = -0.52, p = 0.002); nursing support (r = -0.48, p = 0.01); and knowledge about addiction and its treatment (r = 0.47, p = 0.007); weak relationships were length of stay impact (r = 0.02, p = 0.92), trained clinicians (r = 0.02, p = 0.91), and social complexity (r = -0.10, p = 0.60).
CONCLUSIONS: IF was associated with improved readiness, decreases in barriers and an increase in facilitators of ED BUP. When faced with limited resources, these findings can help inform prioritization of addressable barriers and facilitators to improve readiness for ED BUP.
PubMed ID
41354305
ePublication
ePub ahead of print
First Page
209845
Last Page
209845
