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NEW HAVEN, CT – When opioid dependent patients seek medical care, standard operating procedure for many emergency departments is to deal with their immediate medical issues and then refer them to a treatment program. In some cases, a brief motivational consultation is provided.
Going a step beyond, however, can make a big difference in the likelihood of those patients getting help and cutting back on drug use, according to a new study.
The results of a randomized trial, published recently in the Journal of the American Medical Association, found that patients given the medication buprenorphine in the ED were more likely to engage in addiction treatment and reduce their illicit opioid use.
The study, led by Yale School of Medicine researchers, notes that patients addicted to opioids often seek ED medical care usually are referred for addiction treatment.
“ED physicians take care of the immediate concern, but don’t treat the underlying problem,” said first author Gail D’Onofrio, MD, MS, chair of emergency medicine at Yale.
For the study testing efficacy of an intervention including buprenorphine, the researchers conducted a randomized trial of more than 300 opioid-dependent individuals in an urban teaching hospital.
“Prior research at Yale has demonstrated that buprenorphine treatment is highly effective in primary care, and this study was designed in part to expand the reach of this treatment to this critical ED patient population,” said co-author Patrick O’Connor, MD, MPH, professor of medicine and chief of general internal medicine.
Study participants were screened and then randomized into three groups: a referral group that received a list of treatment services; a brief intervention group that received a motivational consultation and referral; and a third group given a brief intervention and treatment with buprenorphine that was continued in primary care.
Results indicate that 78% of patients in the buprenorphine group, compared to 37% in the referral group and 45% in the brief intervention group, were engaged in addiction treatment on the 30th day after randomization. In addition, the buprenorphine group reduced the number of days of illicit opioid use per week from 5.4 days to 0.9 days as opposed to a reduction from 5.4 days to 2.3 days in the referral group and from 5.6 days to 2.4 days in the brief intervention group.
“The patients who received ED-initiated medication and referral for ongoing treatment in primary care were twice as likely than the others to be engaged in treatment 30 days later,” D’Onofrio noted. “They were less likely to use illicit opioids of any kind.”
The patients treated with buprenorphine in the ED also were less likely to require inpatient treatment in a residential facility.
“Effectively linking ED-initiated buprenorphine treatment to ongoing treatment in primary care represents an exciting new model for engaging patients who are dependent on opioids into state-of-the-art care,” O’Connor said.
D’Onofrio noted that this is “another expanded use of the ED to increase access to treatment options for people with this chronic and relapsing condition.”
The study authors called for replication in other centers before widespread adoption.
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