Researchers at the Yale School of Medicine are leading a four-year, National Institutes of Health-funded study to investigate the implementation and outcomes of new evidence-based treatments for patients with opioid use disorder.
Led by medical school professors Gail D’Onofrio and David Fiellin, the investigation will build off a 2015 study by the same authors, which compared treatment strategies for patients who came into the emergency department for the disorder.
The scientists found that patients at the Yale New Haven Hospital who received the ED-initiated medication buprenorphine had better addiction treatment outcomes. They said they now hope to demonstrate the efficacy of this strategy at four hospitals across the nation in the upcoming study, which has received more than $10 million in funding.
“If we apply this practice consistently throughout the country, we have the opportunity to make a real dent in the problem with opioid addiction,” said Steven Bernstein, a professor at the medical school and co-author on the 2015 study, published in the Journal of the American Medical Association.
This previous study demonstrated that patients who were given a brief counseling intervention and a dose of buprenorphine, which reduces opioid cravings and helps to prevent relapse to opioid use, were twice as likely to be engaged in formal treatment and less likely to use illicit opioids at 30 days after receiving the treatment, according to Bernstein.
This strategy contrasts with current emergency department practices, in which patients are not provided addiction treatment at the emergency room, but are referred to other medical providers instead. The data showed a significant difference in outcomes for patients provided with medication-assisted treatment, D’Onofrio added.
The researchers hope to implement these results throughout the country. They will collaborate with the New England node of the National Institute on Drug Abuse Clinical Trials Network, working with Yale School of Medicine professor Kathleen Carroll and Harvard Medical School professor Roger Weiss.
“This study will try to implement a process, which would be evidence-based, into the health care system in four states and see if they would have such success [as in the Yale New Haven Hospital study],” D’Onofrio said.
The four sites were chosen because they have a high volume of opioid use disorders and were geographically diverse, in addition to having doctors who were interested in the study, according to D’Onofrio. These providers include Johns Hopkins University, the Icahn School of Medicine at Mount Sinai, the University of Cincinnati and the University of Washington.
This study will start at Johns Hopkins in February and then follow a randomized order for researching at the remaining three sites, according to D’Onofrio.
The investigators plan to first examine what the hospitals currently do to treat opioid-use patients as a baseline and then offer a service called implementation facilitation. D’Onofrio defined this as providing the doctors with a bundle of activity that will help them incorporate the strategy into their everyday practice.
“We’re comparing a traditional educational process with one of implementation science,” D’Onofrio said. She explained that the study investigators will provide the sites with better education about treatments, gather opinion leaders and form focus groups — efforts to make the implemented treatments targeted to each specific site.
However, this innovative method of treatment is not standard practice in emergency centers, so the researchers must provide training on how to use the drugs and provide correct doses, Bernstein said.
“There are a lot of barriers to implementing this protocol, but I think that those barriers could be overcome, and I’m hopeful that we can show that we can do that in multiple sites,” D’Onofrio said.
D’Onofrio added that implementing treatment in the emergency department is crucial, as it is often the point of care where a patient is identified to have a substance abuse problem. Opioid use disorder patients who first enter the health care system through the emergency department often don’t have primary care doctors.
Thus, the researchers hope to take advantage of this opportunity to more effectively find the patients and help them obtain treatment.
The researchers believe that through implementing these programs and offering providers specific feedback, this study will advance uptake of this effective opioid addiction treatment process, according to D’Onofrio.
“We’re in a huge opioid epidemic right now, where more people are dying from overdose than in car crashes,” D’Onofrio said. “With this huge public health problem, we’re trying to find the best ways to prevent this loss of life.”