Setting the Stage for Opioid Addiction Treatment

Opioid-dependent patients presenting to an emergency department (ED) for other medical reasons are more likely to pursue addiction treatment if buprenorphine therapy is initiated during their emergency care stay. Although ED providers refer patients identified as opioid-dependent to addiction treatment, they do not necessarily give them the incentive or tools to effectively engage addiction treatment resources, according to a multidisciplinary team of researchers from Yale School of Medicine in New Haven, Connecticut.¹

[[{"type":"media","view_mode":"media_crop","fid":"33919","attributes":{"alt":"opioid dependence","class":"media-image","id":"media_crop_4556241772576","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3712","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 120px; width: 180px; float:right","title":"©Niyaz/Shutterstock","typeof":"foaf:Image"}}]]Because buprenorphine is effective in reducing opioid craving, these researchers assessed the effectiveness of an ED-initiated buprenorphine intervention in 329 patients who presented to the ED of an urban teaching hospital over the course of 4 years. The research was conducted in the context of a randomized controlled trial that compared buprenorphine/naloxone therapy with 2 other interventions.

The patients were selected through a process that screened ED patients using a 20-item health questionnaire in which questions on prescription opioid and heroin use were embedded. Patients who indicated nonmedical prescription opioid use or heroin use in the past 30 days were further evaluated for appropriateness for study inclusion. The Mini-International Neuropsychiatric Interview was used to evaluate opioid use disorder as defined by DSM-IV criteria.

Patients included in the study were randomized to a referral group (n = 104), a brief intervention group (n = 111), or a treatment group (n = 114). The referral group received a list of treatment services, the brief intervention group received a 10- to 15-minute motivational consultation and referral, and the treatment group received the brief intervention and initiation of buprenorphine/naloxone therapy, which was continued in the primary care setting.

The primary outcome was enrollment in and receipt of addiction treatment 30 days after inclusion in the study. At that time, 78% of patients in the treatment group, 45% of the brief intervention group, and 37% of the referral group were engaged in addiction treatment. The difference in addiction-treatment engagement between the treatment and other intervention groups was statistically significant (P < .001). Whereas illicit opioid use was about halved in the referral and brief intervention groups, decreasing from about 5 ½ to slightly less than 2 ½ days per week, it markedly decreased in the treatment group from 5 ½ to 1 day per week.

The patients given buprenorphine/naloxone in the ED were also less likely to require inpatient treatment at a residential facility. Eleven percent used inpatient addiction treatment services compared with 37% in the referral and 35% in the brief intervention.

Although the researchers affirm that their findings need to be confirmed, buprenorphine-based therapy initiated in the ED and continued in the primary care setting holds promise for effectively addressing the chronic and relapsing medical condition that is opioid dependency.

References:

1. D’Onofrio G, O’Connor PG, Pantalon MV, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313:1636-1644. http://jama.jamanetwork.com/article.aspx?articleid=2279713. Accessed June 9, 2015.