2024
Cost-Effectiveness of Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder
Lu T, Ryan D, Cadet T, Chawarski M, Coupet E, Edelman E, Hawk K, Huntley K, Jalali A, O'Connor P, Owens P, Martel S, Fiellin D, D'Onofrio G, Murphy S. Cost-Effectiveness of Implementation Facilitation to Promote Emergency Department-Initiated Buprenorphine for Opioid Use Disorder. Annals Of Emergency Medicine 2024 PMID: 39570250, DOI: 10.1016/j.annemergmed.2024.10.001.Peer-Reviewed Original ResearchHealth care sector perspectiveImplementation facilitatorsOpioid use disorder careIncremental cost-effectiveness ratioCost-effectiveness ratioHealth care sector costsEducational strategiesImplementation facilitation strategyCost-effectiveness acceptability curvesLikelihood of cost-effectivenessCost-effectiveOpioid use disorderQuality-adjusted life yearsUse disorderPatient engagementAcademic EDED visitsAcceptability curvesStandard educationEmergency departmentLife yearsFacilitation strategiesMeasures of effectivenessHealthBuprenorphineTrends in the Prescribing of Buprenorphine for Opioid Use Disorder, 2019-2023
Savitz S, Stevens M, Nath B, D’Onofrio G, Melnick E, Jeffery M. Trends in the Prescribing of Buprenorphine for Opioid Use Disorder, 2019-2023. Mayo Clinic Proceedings Innovations Quality & Outcomes 2024, 8: 308-320. PMID: 38841599, PMCID: PMC11152959, DOI: 10.1016/j.mayocpiqo.2024.04.004.Peer-Reviewed Original ResearchOpioid use disorderTreat alcohol use disorderAlcohol use disorderUse disorderX-waiverMedicare Advantage enrolleesTreat opioid use disorderRate ratiosEvaluate trendsPrescribing of buprenorphineOptumLabs Data WarehouseDaily doseCommercial enrolleesCoronavirus diseasePrescription fillsBuprenorphineDays supplyBuprenorphine prescribingFilling patternBuprenorphine accessImprove buprenorphine accessStudy periodResponse to coronavirus diseasePrescriber typePrescribing
2023
Early emergency department experience with 7‐day extended‐release injectable buprenorphine for opioid use disorder
D'Onofrio G, Perrone J, Hawk K, Cowan E, McCormack R, Coupet E, Owens P, Martel S, Huntley K, Walsh S, Lofwall M, Herring A, Investigators T. Early emergency department experience with 7‐day extended‐release injectable buprenorphine for opioid use disorder. Academic Emergency Medicine 2023, 30: 1264-1271. PMID: 37501652, PMCID: PMC10822018, DOI: 10.1111/acem.14782.Peer-Reviewed Original ResearchConceptsOpioid use disorderEmergency departmentUse disordersSevere opioid use disorderOngoing clinical trialsEuropean Medicines AgencyEmergency department experienceInjectable buprenorphineClinician barriersED patientsED settingEmergency cliniciansInsurance statusClinical trialsReferral sitesDrug AdministrationMedicines AgencyBuprenorphine preparationsMedicationsU.S. FoodTreatment innovationsBuprenorphineDepartment's experienceEarly experienceDisordersURINE TOXICOLOGY PROFILES OF EMERGENCY DEPARTMENT PATIENTS WITH UNTREATED OPIOID USE DISORDER: A MULTI-SITE VIEW
Cowan E, Perrone J, Dziura J, Edelman E, Hawk K, Herring A, McCormack R, Murphy A, Phadke M, Fiellin D, D'Onofrio G. URINE TOXICOLOGY PROFILES OF EMERGENCY DEPARTMENT PATIENTS WITH UNTREATED OPIOID USE DISORDER: A MULTI-SITE VIEW. Journal Of Emergency Medicine 2023, 65: e357-e365. PMID: 37716904, PMCID: PMC10591927, DOI: 10.1016/j.jemermed.2023.06.007.Peer-Reviewed Original ResearchUrine drug screensOpioid use disorderEmergency departmentUntreated opioid use disorderAdult ED patientsOpioid overdose deathsED patientsOnly opioidCommon opioidsOverdose deathsUse disordersCommon drugsOpioidsPolysubstance useDrug useDrug screensAmphetamine-type stimulantsFentanylPatientsAddiction treatmentStimulantsParticipantsBuprenorphineMethadoneBenzodiazepinesNational Institute on Drug Abuse Clinical Trials Network Meeting Report: Advancing Emergency Department Initiation of Buprenorphine for Opioid Use Disorder
Cowan E, Perrone J, Bernstein S, Coupet E, Fiellin D, Hawk K, Herring A, Huntley K, McCormack R, Venkatesh A, D'Onofrio G. National Institute on Drug Abuse Clinical Trials Network Meeting Report: Advancing Emergency Department Initiation of Buprenorphine for Opioid Use Disorder. Annals Of Emergency Medicine 2023, 82: 326-335. PMID: 37178101, PMCID: PMC10524880, DOI: 10.1016/j.annemergmed.2023.03.025.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsOpioid use disorderEmergency departmentUse disordersDrug Abuse Clinical Trials NetworkEffective evidence-based treatmentsEmergency department initiationStandard emergency careMajor public health crisisClinical Trials NetworkEvidence of efficacyNational InstituteEvidence-based treatmentsOpioid overdose deathsTechnology-based interventionsBuprenorphine dosingBuprenorphine initiationPeer-based interventionsPublic health crisisPatient outcomesED staffOverdose deathsEmergency careBuprenorphineTrials NetworkUniversal uptakePerspectives on and experiences of emergency department–initiated buprenorphine among clinical pharmacists: A multi-site qualitative study
Justen M, Edelman E, Chawarski M, Coupet E, Cowan E, Lyons M, Owens P, Martel S, Richardson L, Rothman R, Whiteside L, O'Connor P, Zahn E, D'Onofrio G, Fiellin D, Hawk K. Perspectives on and experiences of emergency department–initiated buprenorphine among clinical pharmacists: A multi-site qualitative study. Journal Of Substance Use And Addiction Treatment 2023, 155: 209058. PMID: 37149149, DOI: 10.1016/j.josat.2023.209058.Peer-Reviewed Original ResearchConceptsOpioid use disorderClinical pharmacistsED careEmergency department-initiated buprenorphineEffective OUD treatmentEffectiveness-implementation studyHealth Services frameworkFocus groups/interviewsMulti-site qualitative studyFuture implementation effortsOUD treatmentUrban EDGroups/interviewsEmergency departmentPromoting ActionUnique pharmacologyED staffBuprenorphinePharmacist participantsUse disordersED contextPharmacistsPractice changePharmacy resourcesSuccessful program implementationPerspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs
Sue K, Chawarski M, Curry L, McNeil R, Coupet E, Schwartz R, Wilder C, Tsui J, Hawk K, D’Onofrio G, O’Connor P, Fiellin D, Edelman E. Perspectives of Clinicians and Staff at Community-Based Opioid Use Disorder Treatment Settings on Linkages With Emergency Department–Initiated Buprenorphine Programs. JAMA Network Open 2023, 6: e2312718. PMID: 37163263, PMCID: PMC10173026, DOI: 10.1001/jamanetworkopen.2023.12718.Peer-Reviewed Original ResearchConceptsCommunity-based cliniciansOpioid use disorderEmergency departmentOUD treatmentMedication treatmentSubstance use disorders trainingUrban academic emergency departmentEffectiveness-implementation studyAcademic emergency departmentDisorder treatment settingsPerspectives of cliniciansCommunity-based treatmentCommunity-based treatment programsStaff perspectivesImplementation science frameworkBuprenorphine programTreatment cliniciansPeer navigatorsReferral sitesPromoting ActionMAIN OUTCOMEED staffBuprenorphineFocus groupsUse disordersIncidence of Precipitated Withdrawal During a Multisite Emergency Department–Initiated Buprenorphine Clinical Trial in the Era of Fentanyl
D’Onofrio G, Hawk K, Perrone J, Walsh S, Lofwall M, Fiellin D, Herring A. Incidence of Precipitated Withdrawal During a Multisite Emergency Department–Initiated Buprenorphine Clinical Trial in the Era of Fentanyl. JAMA Network Open 2023, 6: e236108. PMID: 36995717, PMCID: PMC10064247, DOI: 10.1001/jamanetworkopen.2023.6108.Peer-Reviewed Original ResearchRacial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems
Holland W, Li F, Nath B, Jeffery M, Stevens M, Melnick E, Dziura J, Khidir H, Skains R, D'Onofrio G, Soares W. Racial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems. Academic Emergency Medicine 2023, 30: 709-720. PMID: 36660800, PMCID: PMC10467357, DOI: 10.1111/acem.14668.Peer-Reviewed Original ResearchConceptsOpioid use disorderCommunity emergency departmentsEmergency departmentDischarge diagnosisHealth care systemHispanic patientsBlack patientsHospital typeCare systemNon-Hispanic patientsOpioid overdose deathsClinical decision support systemOpioid withdrawalPrimary outcomeMedication treatmentBuprenorphine accessED treatmentTreatment accessOverdose deathsX-waiverBuprenorphinePatientsUse disordersEthnic disparitiesSecondary analysis
2022
Models for Implementing Emergency Department–Initiated Buprenorphine With Referral for Ongoing Medication Treatment at Emergency Department Discharge in Diverse Academic Centers
Whiteside LK, D'Onofrio G, Fiellin DA, Edelman EJ, Richardson L, O'Connor P, Rothman RE, Cowan E, Lyons MS, Fockele CE, Saheed M, Freiermuth C, Punches BE, Guo C, Martel S, Owens PH, Coupet E, Hawk KF. Models for Implementing Emergency Department–Initiated Buprenorphine With Referral for Ongoing Medication Treatment at Emergency Department Discharge in Diverse Academic Centers. Annals Of Emergency Medicine 2022, 80: 410-419. PMID: 35752520, PMCID: PMC9588652, DOI: 10.1016/j.annemergmed.2022.05.010.Peer-Reviewed Original ResearchConceptsOpioid use disorderUse disordersEmergency Department-Initiated BuprenorphineEmergency department dischargeEmergency department patientsElectronic medical record integrationAcademic medical centerBuprenorphine programDepartment patientsTreatment initiationMedication treatmentEmergency physiciansMedical CenterAmerican CollegeClinical practiceImplementation facilitationQuality improvement processBuprenorphineCommon facilitatorsRecord integrationPatientsReferralED cultureEducational disseminationDisorders
2021
Emergency department‐initiated buprenorphine protocols: A national evaluation
Guo CZ, D'Onofrio G, Fiellin DA, Edelman EJ, Hawk K, Herring A, McCormack R, Perrone J, Cowan E. Emergency department‐initiated buprenorphine protocols: A national evaluation. Journal Of The American College Of Emergency Physicians Open 2021, 2: e12606. PMID: 34877567, PMCID: PMC8630357, DOI: 10.1002/emp2.12606.Peer-Reviewed Original ResearchClinical Opiate Withdrawal ScaleEmergency departmentBUP initiationBUP doseCOWS scoresEmergency department-initiated buprenorphineTreatment-eligible patientsOpioid use disorderOpiate Withdrawal ScaleBUP administrationDischarge careBUP treatmentEvidence-based practiceWithdrawal symptomsNaloxone prescriptionsPatient outcomesWithdrawal ScaleBuprenorphineUse disordersClinician judgmentReal-world settingClinical diagnosisDiagnosis checklistDoseLimited dataConsensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department
Hawk K, Hoppe J, Ketcham E, LaPietra A, Moulin A, Nelson L, Schwarz E, Shahid S, Stader D, Wilson MP, D'Onofrio G. Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department. Annals Of Emergency Medicine 2021, 78: 434-442. PMID: 34172303, DOI: 10.1016/j.annemergmed.2021.04.023.Peer-Reviewed Original ResearchConceptsOpioid use disorderEmergency departmentUse disordersConsensus recommendationsEmergency physiciansUntreated opioid use disorderOpioid use disorder treatmentEmergency Physicians (ACEP) recommendationsInitiation of treatmentInitiation of buprenorphineUse disorder treatmentAppropriate patientsED referralsPhysician recommendationTreatment initiationOngoing treatmentAmerican CollegeClinical experienceTreatment linkageExpert consensusDisorder treatmentDrug usePatientsBuprenorphineClinical researchThe design and conduct of a randomized clinical trial comparing emergency department initiation of sublingual versus a 7-day extended-release injection formulation of buprenorphine for opioid use disorder: Project ED Innovation
D'Onofrio G, Hawk KF, Herring AA, Perrone J, Cowan E, McCormack RP, Dziura J, Taylor RA, Coupet E, Edelman EJ, Pantalon MV, Owens PH, Martel SH, O'Connor PG, Van Veldhuisen P, DeVogel N, Huntley K, Murphy SM, Lofwall MR, Walsh SL, Fiellin DA. The design and conduct of a randomized clinical trial comparing emergency department initiation of sublingual versus a 7-day extended-release injection formulation of buprenorphine for opioid use disorder: Project ED Innovation. Contemporary Clinical Trials 2021, 104: 106359. PMID: 33737199, PMCID: PMC9153252, DOI: 10.1016/j.cct.2021.106359.Peer-Reviewed Original ResearchConceptsOpioid use disorderRandomized clinical trialsPrimary outcomeFormal addiction treatmentOpioid withdrawalClinical trialsAncillary studiesUse disordersSelf-reported opioid useAddiction treatmentEmergency department initiationIncremental cost-effectiveness ratioReceipt of medicationEmergency department studyHealth service utilizationCost-effectiveness ratioOpioid useSecondary outcomesService utilizationTreatment accessEligibility criteriaImplementation facilitationBuprenorphineOverdose eventsDepartment studyImplementation 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
McCormack RP, Rotrosen J, Gauthier P, D’Onofrio G, Fiellin DA, Marsch LA, Novo P, Liu D, Edelman EJ, Farkas S, Matthews AG, Mulatya C, Salazar D, Wolff J, Knight R, Goodman W, Hawk K. 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. Addiction Science & Clinical Practice 2021, 16: 16. PMID: 33750454, PMCID: PMC7941881, DOI: 10.1186/s13722-021-00224-y.Peer-Reviewed Original ResearchConceptsEmergency departmentLow-resource settingsImplementation facilitationUse disordersEmergency department-initiated buprenorphineResource settingsImplementation-effectiveness studyTreatment of OUDOpioid use disorderNon-emergent conditionsSubstance use disordersImplementation feasibility studyOUD interventionsED settingMedical recordsBuprenorphineClinical protocolsHigh needReferral programDisorder screeningDiscussionThis studyImplementation studyAdministrative dataReferralTreatment
2019
User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial
Melnick ER, Jeffery MM, Dziura JD, Mao JA, Hess EP, Platts-Mills TF, Solad Y, Paek H, Martel S, Patel MD, Bankowski L, Lu C, Brandt C, D’Onofrio G. User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial. BMJ Open 2019, 9: e028488. PMID: 31152039, PMCID: PMC6550013, DOI: 10.1136/bmjopen-2018-028488.Peer-Reviewed Original ResearchMeSH KeywordsAdultBuprenorphineCluster AnalysisDecision Support Systems, ClinicalEmergency Service, HospitalFemaleHumansMaleMiddle AgedMulticenter Studies as TopicNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersPragmatic Clinical Trials as TopicRandomized Controlled Trials as TopicUnited StatesYoung AdultConceptsOpioid use disorderEmergency departmentSecondary outcomesUse disordersEmergency department-initiated buprenorphineWestern Institutional Review BoardData Safety Monitoring BoardIndependent study monitorsRates of cliniciansRoutine emergency careSafety monitoring boardInstitutional review boardClinical decision support systemClinician prescribingPragmatic clusterPatient characteristicsPeer-reviewed journalsClinical decision supportPrimary outcomeED cliniciansWithdrawal symptomsOngoing treatmentPatients' willingnessMonitoring boardBuprenorphineComputerized Clinical Decision Support System for Emergency Department–Initiated Buprenorphine for Opioid Use Disorder: User-Centered Design
Ray JM, Ahmed OM, Solad Y, Maleska M, Martel S, Jeffery MM, Platts-Mills TF, Hess EP, D’Onofrio G, Melnick ER. Computerized Clinical Decision Support System for Emergency Department–Initiated Buprenorphine for Opioid Use Disorder: User-Centered Design. JMIR Human Factors 2019, 6: e13121. PMID: 30810531, PMCID: PMC6414819, DOI: 10.2196/13121.Peer-Reviewed Original ResearchOpioid use disorderRoutine emergency careEmergency departmentCare pathwayED initiationClinical decision supportEmergency careUse disordersEmergency Department-Initiated BuprenorphineRoutine ED careComputerized clinical decision support systemsEffective treatment optionClinical decision toolClinical decision support systemED careTreatment optionsBuprenorphineResident physiciansDirect activationCarePatientsDisordersCritical decision pointsInitial observationsPathway
2017
Cost‐effectiveness of emergency department‐initiated treatment for opioid dependence
Busch SH, Fiellin DA, Chawarski MC, Owens PH, Pantalon MV, Hawk K, Bernstein SL, O'Connor PG, D'Onofrio G. Cost‐effectiveness of emergency department‐initiated treatment for opioid dependence. Addiction 2017, 112: 2002-2010. PMID: 28815789, PMCID: PMC5657503, DOI: 10.1111/add.13900.Peer-Reviewed Original ResearchConceptsCost-effectiveness acceptability curvesOpioid dependenceCommunity-based treatmentBrief interventionAcceptability curvesPast weekHealth care system costsHealth care system perspectiveAddiction treatmentOpioid-dependent patientsPatient time costsHealth care useFormal addiction treatmentBuprenorphine treatmentUrban EDEmergency departmentPrimary carePatient engagementTreatment engagementPatientsReferralSecondary analysisBuprenorphineNumber of daysInterventionEmergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention
D’Onofrio G, Chawarski MC, O’Connor P, Pantalon MV, Busch SH, Owens PH, Hawk K, Bernstein SL, Fiellin DA. Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention. Journal Of General Internal Medicine 2017, 32: 660-666. PMID: 28194688, PMCID: PMC5442013, DOI: 10.1007/s11606-017-3993-2.Peer-Reviewed Original ResearchConceptsIllicit opioid useOpioid usePrimary careHIV riskBrief interventionAddiction treatmentBuprenorphine groupEmergency Department-Initiated BuprenorphineCohort of patientsLong-term followLong-term outcomesFormal addiction treatmentSignificant differencesMain MeasuresSelfStudy entryUrine toxicologyBuprenorphine/Opioid dependenceED interventionsUrine resultsBuprenorphineTreatment engagementDrug useReferralPatients