Yale investigators Dr. Gail D’Onofrio and Dr. David Fiellin are leading a NIH-funded study to examine implementation of evidence-based practices for patients with opioid-use disorder coming in to emergency departments (ED). The study will assess practices in New York, Seattle, Cincinnati, and Baltimore.
With more than $10 million in funding, the research effort will involve testing both patient outcomes as well as organizational, ED, and community provider factors that enhance treatment and referral.
Part of the National Institute on Drug Abuse’s (NIDA) Clinical Trials Network, the new study builds on a previous effort by these researchers published in JAMA in 2015. That study compared three treatment strategies for patients with opioid-use disorder who came to the ED. The researchers found that among 329 patients, those who received both a brief counseling intervention with ED-initiated medication, buprenorphine, to reduce cravings and referral to primary care for continued medication and counseling were nearly two times more likely to be engaged in formal treatment at 30 days compared with those offered a brief counseling intervention without referral or referral alone.
Expanding on that effort, the Yale team is collaborating with the New England Node of the NIDA Clinical Trials Network (principal investigators Roger Weiss, M.D., of Harvard and Kathleen Carroll of Yale) and ED and community treatment providers at John Hopkins University, Icahn School of Medicine at Mount Sinai, University of Cincinnati, and the University of Washington.
At each site, the researchers will compare the impact of a brief educational intervention to the use of a bundle of implementation support activities tailored to each site’s circumstances.
The researchers will start with the first site in Baltimore in February 2017, and continue implementation at three other sites on a rolling basis.
“We know there are evidence-based ways to treat opioid use disorder. The challenge is determining the optimal way to implement these treatments in busy settings like Emergency Departments,” says Fiellin, a lead investigator and director of the Community Research and Implementation Core at the Center for Interdisciplinary Research on AIDS at Yale.
“This is an opportunity to use implementation science to test whether we can disseminate successful findings from Yale to multiple sites,” said D’Onofrio, chair of emergency medicine at Yale School of Medicine.
The research, which will span four years, will provide further insight for experts tackling opioid addiction — a crisis that took more than 33,000 lives in 2015.
The study is funded by National Institute on Drug Abuse.