Extended-release Injectable Buprenorphine Initiation in the Emergency Department
Introduction: Extended-release buprenorphine (XR-BUP) is a long-acting injectable medication used for the treatment of opioid use disorder (OUD). It is currently approved for use in patients who have been administered at least seven days of sublingual buprenorphine (SL-BUP). For patients with OUD wh...
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eScholarship Publishing, University of California
2025-07-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/4w26s0k3 |
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| author | Brittany Cesar Jessica Moore Raluca Isenberg Jessica Heil Rachel Rafeq Rachel Haroz Matthew Salzman Alice V. Ely |
| author_facet | Brittany Cesar Jessica Moore Raluca Isenberg Jessica Heil Rachel Rafeq Rachel Haroz Matthew Salzman Alice V. Ely |
| author_sort | Brittany Cesar |
| collection | DOAJ |
| description | Introduction: Extended-release buprenorphine (XR-BUP) is a long-acting injectable medication used for the treatment of opioid use disorder (OUD). It is currently approved for use in patients who have been administered at least seven days of sublingual buprenorphine (SL-BUP). For patients with OUD who are unstable (ie, not at treatment goal, with active opioid use) or not yet on medication for OUD (MOUD) such as SL-BUP, the emergency department (ED) setting is an essential location for access to treatment. There is, as yet, no research on the utility of on-demand XR-BUP administration in the ED. Methods: We performed a retrospective cohort study of individuals with OUD who received XR-BUP in the ED through our novel reallocation pathway. We reviewed charts from an addiction medicine specialty outpatient clinic to determine retention in treatment, continuation on XR-BUP, and reported quantitative analysis. Our primary outcome was retention in treatment, measured by subsequent XR-BUP injection after initial ED XR-BUP administration. The secondary outcome was the reason for ED administration of XR-BUP (as opposed to administration in the clinic setting). Results: Our study population included 69 patients (68.2% male). Our primary outcome showed that 51 (73.9%) patients who had their first injection in the ED received a second XR-BUP injection and 40 (58%) received their third XR-BUP injection. Our secondary outcome showed that 7.2% had barriers with access to treatment; however, most of the patients received the injection due to instability of the treatment of the OUD (69.6%). These patients were either unable to adhere to MOUD, reported issues with the prescription, or were still using substances while on MOUD. For 52 (75%) patients, the index ED injection was their first ever XR-BUP injection. Logistical regression analyses demonstrated that clinical and demographic factors did not lead to increased attrition, while patients with other co-occurring substance use disorders were more likely to present for follow-up treatment. Conclusion: In our retrospective study, patients who received ED-initiated extended-release buprenorphine had a strong retention rate compared to previous studies evaluating ED-initiated sublingual BUP (retention rates ranging from 16.7–60%). The ED provided a convenient healthcare access point for XR-BUP initiation. The XR-BUP is a helpful tool for achieving induction after failed SL-BUP initiation and may have further implications in minimizing treatment gaps after discharge and improving OUD treatment retention. |
| format | Article |
| id | doaj-art-8986bcb6e6db4091aac0a9b4987e7f64 |
| institution | Kabale University |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | eScholarship Publishing, University of California |
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| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-8986bcb6e6db4091aac0a9b4987e7f642025-08-20T03:41:19ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182025-07-0126488889610.5811/westjem.21299wjem-26-888Extended-release Injectable Buprenorphine Initiation in the Emergency DepartmentBrittany Cesar0Jessica Moore1Raluca Isenberg2Jessica Heil3Rachel Rafeq4Rachel Haroz5Matthew Salzman6Alice V. Ely7Cooper University Health Care - Center for Healing, Department of Addiction Medicine, Camden, New JerseyCooper University Health Care - Center for Healing, Department of Addiction Medicine, Camden, New JerseyCooper University Health Care - Center for Healing, Department of Addiction Medicine, Camden, New JerseyCooper University Health Care - Center for Healing, Department of Addiction Medicine, Camden, New JerseyCooper University Health Care, Department of Emergency Medicine, Camden, New JerseyCooper Medical School of Rowan University, Camden, New JerseyCooper University Health Care, Department of Emergency Medicine, Camden, New JerseyCooper University Health Care - Center for Healing, Department of Addiction Medicine, Camden, New JerseyIntroduction: Extended-release buprenorphine (XR-BUP) is a long-acting injectable medication used for the treatment of opioid use disorder (OUD). It is currently approved for use in patients who have been administered at least seven days of sublingual buprenorphine (SL-BUP). For patients with OUD who are unstable (ie, not at treatment goal, with active opioid use) or not yet on medication for OUD (MOUD) such as SL-BUP, the emergency department (ED) setting is an essential location for access to treatment. There is, as yet, no research on the utility of on-demand XR-BUP administration in the ED. Methods: We performed a retrospective cohort study of individuals with OUD who received XR-BUP in the ED through our novel reallocation pathway. We reviewed charts from an addiction medicine specialty outpatient clinic to determine retention in treatment, continuation on XR-BUP, and reported quantitative analysis. Our primary outcome was retention in treatment, measured by subsequent XR-BUP injection after initial ED XR-BUP administration. The secondary outcome was the reason for ED administration of XR-BUP (as opposed to administration in the clinic setting). Results: Our study population included 69 patients (68.2% male). Our primary outcome showed that 51 (73.9%) patients who had their first injection in the ED received a second XR-BUP injection and 40 (58%) received their third XR-BUP injection. Our secondary outcome showed that 7.2% had barriers with access to treatment; however, most of the patients received the injection due to instability of the treatment of the OUD (69.6%). These patients were either unable to adhere to MOUD, reported issues with the prescription, or were still using substances while on MOUD. For 52 (75%) patients, the index ED injection was their first ever XR-BUP injection. Logistical regression analyses demonstrated that clinical and demographic factors did not lead to increased attrition, while patients with other co-occurring substance use disorders were more likely to present for follow-up treatment. Conclusion: In our retrospective study, patients who received ED-initiated extended-release buprenorphine had a strong retention rate compared to previous studies evaluating ED-initiated sublingual BUP (retention rates ranging from 16.7–60%). The ED provided a convenient healthcare access point for XR-BUP initiation. The XR-BUP is a helpful tool for achieving induction after failed SL-BUP initiation and may have further implications in minimizing treatment gaps after discharge and improving OUD treatment retention.https://escholarship.org/uc/item/4w26s0k3 |
| spellingShingle | Brittany Cesar Jessica Moore Raluca Isenberg Jessica Heil Rachel Rafeq Rachel Haroz Matthew Salzman Alice V. Ely Extended-release Injectable Buprenorphine Initiation in the Emergency Department Western Journal of Emergency Medicine |
| title | Extended-release Injectable Buprenorphine Initiation in the Emergency Department |
| title_full | Extended-release Injectable Buprenorphine Initiation in the Emergency Department |
| title_fullStr | Extended-release Injectable Buprenorphine Initiation in the Emergency Department |
| title_full_unstemmed | Extended-release Injectable Buprenorphine Initiation in the Emergency Department |
| title_short | Extended-release Injectable Buprenorphine Initiation in the Emergency Department |
| title_sort | extended release injectable buprenorphine initiation in the emergency department |
| url | https://escholarship.org/uc/item/4w26s0k3 |
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