“Opioid use disorder, dependence on prescription opioids and heroin, is a major public health problem taking a devastating toll on Americans, their families, and their communities. Three million Americans have or have had opioid use disorder,” wrote Dr. Ted Melnick and Dr. Gail D’Onofrio in their proposal to the National Institute on Drug Abuse (NIDA).
In a landmark Yale study reported in JAMA in 2015, D’Onofrio and her team found that initiating buprenorphine, a medication for addiction treatment, in the emergency department doubled the rate of patients still in treatment at 30-days. But in emergency departments, the practice of initiating buprenorphine treatment has not been effectively implemented.
“The ER is the only access to health care for many individuals suffering from opioid use disorder,” said Melnick. “Buprenorphine is a well-established, outpatient treatment for opioid use disorder with multiple bureaucratic and medical barriers to implementation in the ER. To overcome these barriers and make this treatment available to this vulnerable population as a part of routine ER care, we will leverage cutting edge health IT innovations and user-centered design so that our intervention works within the dynamic ER clinical environment.”
Melnick and D’Onofrio, researchers at Yale School of Medicine, have just received the first year of funding from NIDA in the amount of $819,454 to develop this health information technology intervention and deploy it across multiple healthcare systems. If they successfully meet the first-year project milestones, NIDA will fund a $6.6 million, four-year, multicenter trial to test the intervention across these systems.
According to Melnick and D’Onofrio, “This trial will answer the critical implementation question in opioid use disorder care: ‘What is the best way to maximize the rate of adoption of emergency department-initiated buprenorphine and referral to medication assisted treatment?’”
D’Onofrio, professor of emergency medicine and chair of the Department of Emergency Medicine, is internationally known for her work in screening emergency department patients for alcohol and other drug use, brief intervention, and referral to treatment. Melnick, assistant professor of emergency medicine and director of the Clinical Informatics Fellowship, focuses on improving electronic health record usability to optimize health care delivery.