An Evaluation of the Buprenorphine-Naloxone Treatment Protocol Initiated at the Battlefords Union Hospital Emergency Department

By: Brady Bouchard, Daniel Garcia, Keara Minish, Rhonda Bryce, & Vivian Ramsden

Background: Buprenorphine-naloxone opioid agonist therapy (OAT) is first-line treatment of opioid use disorder (OUD). Buprenorphine-naloxone OAT initiated in the Emergency Department (ED) is associated with successful primacy care engagement due to safe, unobserved, take-home dosing. There is a paucity of evidence evaluating patient retention of buprenorphine-naloxone OAT initiated in a rural ED setting.

Research Question(s): To evaluate patient adherence with buprenorphine-naloxone OAT initiated at the Battlefords Union Hospital (BUH) ED for OUD.

Methods/Methodology: A retrospective chart review for this cross-sectional study was performed on all patients initiating buprenorphine-naloxone at the BUH for OUD from January 1, 2019 to January 1, 2020. Variables: (1) Treatment follow-up (months); (2) active buprenorphine-naloxone prescription; (3) primary care attendance; (4) expected vs unexpected urine drug screen (UDS); and (5) demographics of age and gender. Fisher’s exact and Mann-Whitney-U testing was used for comparisons by follow-up and active prescription status.

Results/Findings: Twelve participants were initially included; one participant was lost to follow-up. Analysis included 7 female and 4 male participants at the time of data collection (April 2020). Active buprenorphine-naloxone prescriptions were held by 54.5% (6/11); 90.9% (10/11) attended follow-up after ED initiation. Females had a retention rate of 42.9% (3/7) compared to men at 75% (3/4). Of the 54.5% of participants with an active prescription, 100% (6/6) attended follow-up primary care appointments; of those without an active buprenorphine-naloxone prescription, 80% (4/5) also attended (p=0.46). Of participants with an expected UDS, 75% (6/8) maintained an active prescription and 25% (2/8) did not. All participants with an active prescription provided an expected UDS compared to 40% of those without an active prescription (2/5) (p=0.06). None of the study participants were previously prescribed methadone.

Conclusions: Our study provides preliminary evidence supporting successful retention and adherence of buprenorphine-naloxone in primary care when initiated in a rural ED for OUD.

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