Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study

Ryan P McCormack, John Rotrosen, Phoebe Gauthier, Gail D'Onofrio, David A Fiellin, Lisa A Marsch, Patricia Novo, David Liu, E Jennifer Edelman, Sarah Farkas, Abigail G Matthews, Caroline Mulatya, Dagmar Salazar, Jeremy Wolff, Randolph Knight, William Goodman, Kathryn Hawk, Ryan P McCormack, John Rotrosen, Phoebe Gauthier, Gail D'Onofrio, David A Fiellin, Lisa A Marsch, Patricia Novo, David Liu, E Jennifer Edelman, Sarah Farkas, Abigail G Matthews, Caroline Mulatya, Dagmar Salazar, Jeremy Wolff, Randolph Knight, William Goodman, Kathryn Hawk

Abstract

Background: For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study, its rapid funding mechanism, and accelerated timeline originated out of the urgent need to learn whether ED-initiated buprenorphine (BUP) with referral for treatment of OUD is generalizable, as well as to develop strategies to facilitate its adoption across a variety of ED settings and under real-world conditions. It both complements and uses methods adapted from Project ED Health (CTN-0069), a Hybrid Type 3 implementation-effectiveness study of using Implementation Facilitation (IF) to integrate ED-initiated BUP and referral programs.

Methods: ED-CONNECT (CTN 0079) was a three-site implementation study exploring the feasibility, acceptability, and impact of introducing ED-initiated BUP in rural and urban settings with high-need, limited resources, and different staffing structures. We used a multi-faceted approach to develop, introduce and iteratively refine site-specific ED clinical protocols and implementation plans for opioid use disorder (OUD) screening, ED-initiated BUP, and referral for treatment. We employed a participatory action research approach and use mixed methods incorporating data derived from abstraction of medical records and administrative data, assessments of recruited ED patient-participants, and both qualitative and quantitative inquiry involving staff from the ED and community, patients, and other stakeholders.

Discussion: This study was designed to provide the necessary, time-sensitive understanding of how to identify OUD and initiate treatment with BUP in the EDs previously not providing ED-initiated BUP, in communities in which this intervention is most needed: high need, low resource settings.

Trial registration: The study was prospectively registered on ClinicalTrials.gov (NCT03544112) on June 01, 2018: https://ichgcp.net/clinical-trials-registry/NCT03544112 .

Keywords: Buprenorphine; Emergency service; Implementation science; Opioid use disorder.

Conflict of interest statement

We have no disclosures to report.

Figures

Fig. 1
Fig. 1
Diagram of patient-participant enrollment and outcomes

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