In this issue, we collaborated with the CJEM team to create a visual abstract on the article “Barriers and attitudes reported by Canadian emergency physicians regarding the initiation of buprenorphine/ naloxone in the emergency department for patients with opioid use disorder”1.
Mortality as a result of opioid use has increased since the start of the COVID-19 pandemic, in part driven by an increasingly toxic drug supply and by increased social isolation and difficulty in accessing support services2. Patients with opioid use disorder (OUD) frequently present to the emergency department (ED) with withdrawal, overdose, and complications from intravenous use. In these patients, who often present with multiple physical health, mental health, and social issues, it’s pretty amazing to think that there is one single intervention proven to reduce subsequent mortality, morbidity, and healthcare resource use. This intervention is the initiation of buprenorphine/naloxone (suboxone).
Easier said than done you might say, and you would not be alone in thinking this. Unfortunately, there are many barriers to starting buprenorphine/naloxone in the ED, and it is not frequently started in this setting. In this study, Savage and Ross used survey data to identify Canadian Emergency Medicine (EM) physicians’ perceived barriers and attitudes towards starting buprenorphine/naloxone in the ED.
The authors found that the majority of respondents reported at least one barrier to starting buprenorphine/naloxone in the ED (97.5%). The most commonly reported barriers were: (1) Lack of allied healthcare staff who could assist in medication start and arranging follow-up (78%), (2) Time constraints on patient education for this treatment (73.7%), and (3) Lack of access to follow-up resources (63.6%). Most respondents agreed that buprenorphine/naloxone was an evidence-based treatment for OUD and were interested in making changes in their own EDs to help facilitate its use.
This study highlights the need for increased institutional support surrounding the start of this life-saving medication, as well as the need for physician education surrounding treatment protocols that can address some of these barriers such as home inductions or micro-dosing.
- Savage T, Ross M. Barriers and attitudes reported by Canadian emergency physicians regarding the initiation of buprenorphine/naloxone in the emergency department for patients with opioid use disorder. CJEM. Published online September 25, 2021. doi:10.1007/s43678-021-00191-y
- Special Advisory Committee on the Epidemic of Opioid Overdoses. Ottawa: Public Health Agency of Canada. Opioid and Stimulant-related Harms in Canada. Government of Canada. Published September 28, 2021. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/