Emergency medicine resident Dr. Kevin Duncan studies patient opinion and acceptance of ED buprenorphine/naloxone to-go home initiation packs

Buprenorphine/naloxone to-go is a well-regarded and acceptable treatment initiation strategy for patients with opioid use disorder who visit the Emergency Department (ED), according to a new study by UBC Department of Emergency Medicine (DEM) RCPSC-EM resident Dr. Kevin Duncan and UBC DEM clinical professor Dr. Andrew Kestler. However, this form of opioid agonist therapy, which prevents withdrawal and reduces cravings for opioid drugs, does not suit all patients’ needs and should therefore be integrated with comprehensive addiction care services including other options for opioid agonist therapy.

Patient opinion and acceptance of emergency department buprenorphine/naloxone to-go home initiation packs” was published in the Canadian Journal of Emergency Medicine. The study surveyed patients with opioid use disorder at two urban EDs in British Columbia, looking at opinions and acceptance of this treatment.

Nearly 80 percent of patients surveyed had a favourable view of this strategy, believing that EDs should dispense this treatment. However, fewer than half of patients participating in this study accepted the treatment.

“Through conversations with several of the participants in this study, I learned how treatment of opioid use disorder needs to be tailored to each individual and the circumstances of their life at that time,” said Dr. Duncan. “Many of the participants realized that buprenorphine/naloxone was not a good treatment option for them at the moment, but they were supportive of it being available as it could be a good option for a peer or even themselves later.”

Opioid overdose death continues to be a substantial cause of Canadian mortality. People with opioid use disorder use EDs more frequently than their peers without opioid use disorder, and ED patients with opioid overdose have a one-year mortality rate of 5.4 percent. Buprenorphine/naloxone has been shown to decrease mortality, reduce opioid use, decrease the need for inpatient addiction treatment services, and increase engagement in outpatient addiction treatment.

“Opioid use disorder is something we encounter daily in the emergency department and has a catastrophic effect on individual lives and our communities,” added Dr. Duncan. “This study demonstrated that there is no one solution to combating the opioid crisis. Although buprenorphine/naloxone to-go will be accepted by two fifths of patients with opioid use disorder, it does need to be part of a robust system for addiction care.”

Many patients with opioid use disorder are not in sufficient withdrawal to undergo ED-based buprenorphine/naloxone initiation. Buprenorphine/naloxone to-go is a low-barrier treatment option for home-based opioid agonist therapy initiation.   

Co-contributors to this study include fellow UBC DEM researchers Dr. Frank Scheuermeyer, Dr. Jessica Moe, Dr. Isabelle Miles and Dr. Jim Christenson.

This study was funded by a grant from the Canadian Institutes of Health Research to the Canadian Research Initiative in Substance Misuse and by a grant from the Providence Health Care and Vancouver Coastal Health Research Institutes.