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A treatment for opioid use disorder, developed by Yale doctors, is being adopted in emergency departments across the country.

Yale doctors — professor of emergency medicine Gail D’Onofrio, assistant professor of emergency medicine Kathryn Hawk and Director of the Yale Program in Addiction Medicine David Fiellin — developed a model for treating opioid use disorder using the drug buprenorphine. The Yale team, led by D’Onofrio and Fiellin, found in 2015 that patients given the medication buprenorphine were more likely to engage in addiction treatment. Since then, the use of buprenorphine has increased in emergency departments across the country.

According to a 2020 research report by D’Onofrio and Fiellin, published in The Journal of the American Medical Association, buprenorphine was used for treatment during more than 441,000 emergency department visits from 2002 to 2017. The report outlines the increased use of buprenorphine from 12.3 per 100,000 emergency department visits in 2002-03 to 42.8 per 100,000 emergency department visits in 2016-17.

“We developed this model over 10 years ago,” Fiellin wrote in a statement to the News. “The main driver in developing this new model of treatment, Emergency Department-initiated buprenorphine with follow up for ongoing treatment in primary care was the large number of patients who were not getting the gold standard of care, medication for opioid use disorder, after their ED visit.”

In many instances, individuals who come to an emergency department after an opioid overdose are given medication and do not continue treatment beyond the visit. Using the model developed by Yale doctors, patients continue treatment for opioid use disorder after their visit.

However, in the case of other serious medical conditions that require a visit to an emergency department, such as asthma, patients are given medication as well as a referral to their primary care doctor to continue their medical care. Adapting this model of treatment with buprenorphine, the team of Yale doctors is looking to expand this practice of extended follow-up care to treat opioid use disorder in the United States.

“Too often patients have life saving surgeries like valve replacements due to injection drug use but are not given the medications and skills to remain healthy,” D’Onofrio wrote to the News.

The use of buprenorphine in treatment is proving to be successful, according to D’Onofrio. She explained that patients with opioid use disorder who are prescribed opioid agonists such as buprenorphine and the drug methadone experience less craving and are more likely to continue participating in treatment, less likely to use non-prescribed opioids and less likely to develop or transmit infections.

Effective treatments for opioid use disorder are becoming increasingly needed — in part due to the COVID-19 pandemic. In an Oct. 30 issue brief, the American Medical Association expressed that they are “greatly concerned by an increasing number of reports from national, state and local media suggesting increases in opioid- and other drug-related mortality.”

D’Onofrio expressed her concern for the exacerbation of opioid use disorder amid the pandemic.

“Many patients with opioid use disorder have chronic illnesses or behaviors which are risk factors for developing or worsening a COVID-19 infection,” she wrote. “It is even more imperative that we offer low barrier access to care.”

Along with associate professor of emergency medicine Ted Melnick, D’Onofrio is also working on EMBED — Emergency Department-Initiated Buprenorphine for Opioid Use Disorder. According to Melnick, this project “integrates a user-centered digital intervention to increase adoption of best practices for addiction treatment in the ED.”

D’Onofrio believes integrating these tools with EMBED has the potential to continue to improve buprenorphine’s adoption in emergency departments across the country.

The team at Yale — along with co-investigators throughout the United States — is now using funding from the National Institute of Health to work with over 30 emergency departments in the United States to implement this buprenorphine treatment model into practice. Additionally, they are conducting a randomized clinical trial in which they compare different formulations of buprenorphine when treating patients seven days and 30 days after their initial emergency department visit.

With data supporting their methods, the team of Yale doctors look toward the promising impacts of implementing their treatment methods nationwide.

“We have the potential to save lives,” D’Onofrio wrote in an email to the News. “We know that almost 5% of patients who present with a nonfatal opioid overdose will die in the next 12 months. We know that only 30% are placed on an opioid agonist. We also know that individuals on methadone or buprenorphine have a reduction in mortality of over 50%.”

According to preliminary data from the Centers for Disease Control, there were 50,042 opioid overdose deaths in the U.S. in 2019.


Erin Bailey | erin.bailey@yale.edu

ERIN BAILEY
Erin Bailey is a copy editor on the managing board and is also a contributing reporter to the science and technology desk. Originally from Denver, Colorado, Erin is a sophomore in Davenport College studying biology.