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Barriers and facilitators for emergency department initiation of buprenorphine: A physician survey

  • Margaret Lowenstein
    Correspondence
    Corresponding author at: 1310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, United States of America.
    Affiliations
    National Clinician Scholars Program, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America

    Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States of America

    The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
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  • Austin Kilaru
    Affiliations
    National Clinician Scholars Program, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America

    The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America

    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America

    Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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  • Jeanmarie Perrone
    Affiliations
    The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America

    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America

    Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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  • Jessica Hemmons
    Affiliations
    Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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  • Dina Abdel-Rahman
    Affiliations
    Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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  • Zachary F. Meisel
    Affiliations
    The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America

    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America

    Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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  • M. Kit Delgado
    Affiliations
    The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America

    Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America

    Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America

    Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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Published:February 18, 2019DOI:https://doi.org/10.1016/j.ajem.2019.02.025
      Implementation of evidence-based pharmacotherapy for individuals with opioid use disorder (OUD) is a cornerstone of the response to the opioid crisis [
      Understanding the epidemic. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention.
      ]. ED-initiated OUD treatment with buprenorphine has been shown to increase treatment engagement at 30 days [
      • D'Onofrio G.
      • O'Connor P.G.
      • Pantalon M.V.
      • et al.
      Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.
      ], but this practice has not been widely adopted [
      • Martin A.
      • Mitchell A.
      • Wakeman S.
      • White B.
      • Raja A.
      Emergency department treatment of opioid addiction: an opportunity to Lead.
      ]. To better develop strategies for implementation, we sought to 1) describe ED physician preparedness to treat OUD and 2) rank physician-perceived barriers and facilitators of ED administration of buprenorphine and obtaining a Drug Addiction Treatment Act of 2000 waiver to prescribe buprenorphine (X-waiver).

      Keywords

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