Pragmatic implementation of strategic interventions to improve initiation of MOUD within Emergency Departments

About This Grant

Robust, evidence-based treatments for Opioid use disorder (OUD) exist but substantial gaps remain in utilization and access, especially among marginalized populations. Emergency Departments (EDs), as a locus for 24/7 treatment access is an evidence- based strategy for initiation of buprenorphine with variable adoption. This study aims to evaluate pragmatic strategies to enhance the ED initiation of buprenorphine for OUD, leveraging locally adapted protocols across two health systems, Penn and Jefferson. These strategies include enhanced patient identification through triage screening, clinician supported buprenorphine initiation, specially trained peer navigation and low barrier follow up options via Penn's CareConnect virtual telehealth and Jefferson's Bridge Program. An additional innovation is to assess patient choice in medication strategies by also offering methadone initiation with next day follow up at Opioid Treatment Program (OTP) partners. Through collaboration with stakeholders, including those with OUD lived experience, we will develop a comprehensive toolkit to increase MOUD initiation in EDs, addressing barriers such as lack of clinician experience and follow-up options. We will assess prescribing rates, patient and provider engagement, and MOUD treatment within 30 days of ED discharge. Sustainability will be evaluated by measuring ongoing costs of the programs. Based on our prior experiences leading interventions to enhance MOUD prescribing at our own institutions and across other research networks, we propose organizing a learning and research collaborative as part of the coordinating center role of the Opioid Prevention, Treatment and Research Network (OPTRN) that can be a forum for sharing and vetting strategies to enhance rates of buprenorphine and methadone initiation. The learning collaborative will leverage the experience of collaborating sites within the network that demonstrate higher rates of buprenorphine initiation as well as visiting “content experts” who can contribute to focused webinars to address implementation and uptake challenges and to support the sites in evaluating outcomes across the network. We will also develop a network website as a communication and sharing platform to enhance shared knowledge and approaches especially important in a community of emergency clinicians with highly variable clinical schedules. Our findings will inform the development of scalable, sustainable interventions to reduce overdose-related mortality.