Timely Initiation of Treatment Improves Opioid Use

Timely Initiation of Treatment Improves Opioid Use Disorder Outcomes

Researchers at the University of Pennsylvania’s School of Medicine have discovered that a program which was designed to make buprenorphine administration timely and easy has increased the use of the treatment in hospital emergency departments significantly. Buprenorphine is a drug that’s used to stabilize opioid withdrawal and pacify cravings. The medication’s use can decrease overdose deaths and other complications associated with drug use while growing long-term engagement with care for opioid use disorder.

The lead author of the study, Margaret Lowenstein, stated that the researchers utilized a behavioral design approach to make the execution of evidence-based treatment timely, attractive and easy. She explained that initially they were focused on prescribing the treatment but then realized that for the program to be effective, barriers such as engaging patients in care needed to be overcome. This led them to focus on helping providers identify treatment opportunities, decrease the friction associated with prescribing and supporting care linkage as well as patient engagement.

For their study, the researchers first made buprenorphine prescribing easier by increasing the number of physicians allowed to prescribe it. To obtain authorization, physicians needed to complete certain training courses after registering on a government website. After successful completion, each clinician was awarded an X-waiver.

The research clinical team then used a couple of strategies to promote the use of this treatment for opioid use disorder. This was led by the co-author of the study, Jeanmarie Perrone, who is director of the Penn Medicine Center for Addiction Medicine and Policy.

The clinical team introduced a financial-incentive system that rewarded clinicians for completing the training, which grew the number of authorized providers to 90%. The team also influenced social norms to prescribe the treatment more often and increased motivation by congratulating physicians for administering the treatment, publicly.

After this, the researchers then identified patients in need of the treatment through their e-health records and connected them to peer-recovery specialists. Data from the program, which began in March 2017 and ended in July 2021, demonstrated improvement in the rate of opioid use disorder patients receiving buprenorphine in the emergency department. During the 18-month period, the number increased to 23% from a mere 3%.

The researchers also found that the rate of use was sustained, with the number of clinicians who prescribed the medication at least once jumping to 70% from less than 10%.

The study’s findings were published in “Annals of Emergency Medicine.” The research was partly funded by grants from the National Institute of Child Health and Human Development, the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention, among other organizations.

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