Patient acceptance of emergency department-initiated buprenorphine and reasons for declining
Lindsey K. Jennings,
Allison Smith,
Angela Moreland,
Ralph Ward,
Sarah Gainey,
Suzanne Lane,
Olivia Holodnik,
Katherine Scarpino,
Karen Hartwell,
Louise Haynes,
Kathleen T. Brady,
Kelly Barth
Affiliations
Lindsey K. Jennings
Medical University of South Carolina, Department of Emergency Medicine, 169 Ashley Avenue, MSC 300, Charleston, SC, 29425, USA; Corresponding author.
Allison Smith
Medical University of South Carolina, Department of Psychiatry and Behavioral Science, Addiction Sciences Division, 67 President Street, Charleston, SC, 29425, USA
Angela Moreland
Medical University of South Carolina, Department of Psychiatry and Behavioral Science, Addiction Sciences Division, 67 President Street, Charleston, SC, 29425, USA
Ralph Ward
Medical University of South Carolina, Department of Public Health Sciences, 135 Cannon St., Suite 303 MSC 835, Charleston, SC, 29425, USA
Sarah Gainey
Medical University of South Carolina, Department of Psychiatry and Behavioral Science, Addiction Sciences Division, 67 President Street, Charleston, SC, 29425, USA
Suzanne Lane
Medical University of South Carolina, Department of Psychiatry and Behavioral Science, Addiction Sciences Division, 67 President Street, Charleston, SC, 29425, USA
Olivia Holodnik
Medical University of South Carolina, Department of Emergency Medicine, 169 Ashley Avenue, MSC 300, Charleston, SC, 29425, USA
Katherine Scarpino
Medical University of South Carolina, Department of Emergency Medicine, 169 Ashley Avenue, MSC 300, Charleston, SC, 29425, USA
Karen Hartwell
Medical University of South Carolina, Department of Psychiatry and Behavioral Science, Addiction Sciences Division, 67 President Street, Charleston, SC, 29425, USA
Louise Haynes
Medical University of South Carolina, Department of Psychiatry and Behavioral Science, Addiction Sciences Division, 67 President Street, Charleston, SC, 29425, USA
Kathleen T. Brady
Medical University of South Carolina, Department of Psychiatry and Behavioral Science, Addiction Sciences Division, 67 President Street, Charleston, SC, 29425, USA
Kelly Barth
Medical University of South Carolina, Department of Psychiatry and Behavioral Science, Addiction Sciences Division, 67 President Street, Charleston, SC, 29425, USA
Background: Medication for Opioid Use Disorder (MOUD) reduces morbidity and mortality for patients with opioid use disorder (OUD). Emergency department-initiated buprenorphine (EDIB) doubles retention in treatment at 30 days compared to outpatient referral alone. Little is known about acceptance rates of EDIB and reasons why patients decline this life-saving intervention. Objectives: The aim of this study was to quantify the number of patients who initiate and decline buprenorphine in the ED and determine reasons for declination. Methods: Seven SC EDs implemented EDIB programs that included ED-based peer recovery specialists (PRSs) to provide a brief intervention and assist with referral to outpatient treatment. The PRSs recorded patient interactions in a database including medical eligibility, if EDIB was provided, and the reason(s) why eligible patients declined EDIB. All eligible EDIB patients were entered in the PRS database and included in the study. Reasons for declining buprenorphine in eligible patients were analyzed with both fixed and free-text response options. Results: A total of 2205 patients were eligible for EDIB. Of those, 963 (43.6 %) patients accepted buprenorphine and 1242 (56.3 %) declined. The most common reasons for declination were 1) the “patient preferring non-MOUD treatment” (53.4 %), 2) “Not ready/would like to think about it and/or check with other treatment providers or case workers” (16.7 %). Conclusions: Over half of patients with OUD who were eligible for EDIB declined treatment, with the most common reason being preference for non-MOUD treatment. Given the success of MOUD for treatment of OUD, this topic requires further exploration.
