Factors associated with frequent buprenorphine / naloxone initiation in a national survey of Canadian emergency physicians

PLoS One. 2024 Feb 5;19(2):e0297084. doi: 10.1371/journal.pone.0297084. eCollection 2024.

Abstract

Objective: To identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs.

Methods: We surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with <50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence.

Results: We excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup.

Conclusions: Individual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD.

MeSH terms

  • Buprenorphine* / therapeutic use
  • Buprenorphine, Naloxone Drug Combination / therapeutic use
  • Canada / epidemiology
  • Cognition
  • Emergency Service, Hospital
  • Humans
  • Naloxone / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Opioid-Related Disorders* / complications
  • Opioid-Related Disorders* / drug therapy
  • Opioid-Related Disorders* / epidemiology

Substances

  • Buprenorphine
  • Narcotic Antagonists
  • Buprenorphine, Naloxone Drug Combination
  • Naloxone

Grants and funding

AK, JKac, AO, KD are named co-investigators on a Canadian Institute of Health Research (https://cihr-irsc.gc.ca/e/193.html) Grant NRF # 154893 to Principal Investigator Julie Bruneau. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.