ObjectiveTo 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.MethodsWe 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 C-vitamin 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 ResultsWe 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 Painting [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.ConclusionsIndividual 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.