By Jim Lloyd, Cadence Bowden, and Kylie Davidson

Our New Jersey State Policy Lab pilot project to examine facilitators and barriers to buprenorphine use in New Jersey’s emergency departments (EDs) for patients presenting with opioid use disorder (OUD) is a timely contribution to the research on this emerging and important topic. Our recent work has shown that patients who experience overdose are much less likely to experience a subsequent overdose after they leave the hospital if they are provided medication for opioid use disorder (MOUD) in the ED. Risk for repeat overdose was 65% lower for patients prescribed MOUD at the time of their first overdose, and patients who received MOUD at any point in follow up had a repeat overdose rate of 10.5%, compared to 22.1% among those not prescribed MOUD.

One key need reported in the literature for successful integration of buprenorphine into EDs is more training for staff. Our researchers have found that insufficient training can act as a barrier to buprenorphine use in EDs in New Jersey, a finding supported by numerous studies elsewhere. Dong et al interviewed ED physicians across the country, and participants indicated that physicians who had received training in this area felt they should address patients’ addiction medicine needs more than those who had not, and the participants suggested that creating an incentive for the training may lead to higher rates of prescription. Im et al, surveying and interviewing ED clinicians about buprenorphine use in their facilities, also found that participants reported that the availability of training contributed to the successful treatment of patients with OUD.

New Jersey established Centers of Excellence for Medication Assisted Treatment for substance use disorders, and our earlier research indicated that the support opportunities these Centers provide have contributed to the successful expansion of access to buprenorphine in the state. This current project is a valuable opportunity to examine what training and support are readily available to ED staff in New Jersey and determine areas for improvement.

Another key area identified in the literature was the support that peer recovery coaches could provide to patients receiving buprenorphine. Schoenfeld et al interviewed patients in EDs about their experiences with MOUD and reported that several interviewees cited the potential value of peer recovery coaches in that setting. Further, Collins et al examined implementation of a statewide program in Rhode Island for treating patients with OUD in EDs, and interviewees considered peer recovery specialists “integral” to the success of the program. The integration of peer support specialists is already underway in New Jersey, and our study will be able to identify facilitators and barriers to the implementation of such programs.

Our project builds upon existing literature by examining key questions left unanswered in previous research. By combining quantitative and qualitative analyses to paint a more complete picture of buprenorphine use in EDs in New Jersey, we will add to this robust evidence base.