High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder

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Abstract
Initiation of buprenorphine for the treatment of opioid use disorder (OUD) in the emergency department (ED), combined with linkage to outpatient care, is an effective strategy to reduce mortality and morbidity among persons living with opioid addiction.1,2 With a total of 50 042 lives lost in 2019 because of opioid overdose deaths, projections of a 30% increase in 2020, and evidence that ED-initiated buprenorphine is both life-saving and cost-effective, the American College of Emergency Physicians, the US Surgeon General, the National Institute of Drug Abuse, and the Substance Abuse and Mental Health Services Administration have all called for ED access to initiation of buprenorphine for treatment of OUD.3-6 Yet, patients frequently face substantial barriers to obtaining buprenorphine in a timely manner after ED discharge because of a lack of ED clinicians with US Drug Enforcement Agency X-waivers permitting them to prescribe buprenorphine or other logistical issues in filling prescriptions associated with prior authorization requirements, transportation, and health insurance coverage gaps.7-11

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