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BMC Emergency Medicine

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01-12-2021 | Buprenorphine | Research

A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department

Authors: David Wiercigroch, Patricia Hoyeck, Hasan Sheikh, Jennifer Hulme

Published in: BMC Emergency Medicine | Issue 1/2021

Abstract

Background

Emergency departments (EDs) across Canada are increasingly prescribing buprenorphine for opioid use disorder (OUD). The objective of this study was to identify the current knowledge, attitudes, and behaviours of ED physicians on the management of OUD in the ED, including barriers and facilitators to prescribing buprenorphine.

Methods

We purposefully selected emergency physicians from one ED in Toronto which had recently received education on OUD management and had a new addiction medicine follow-up clinic, to participate in semi-structured interviews. We used semi-structured interviews to explore experiences with patients with OUD, conceptions of role of the ED in addressing OUD, and specifically ask about perceptions and experience on using buprenorphine for opioid withdrawal. Our analysis was informed by constructivist grounded theory to help uncover contextualized social processes and focus on what people do and why they do it. Two researchers independently coded transcripts using an iterative constant comparative and interpretative approach.

Results

Results fell broadly into facilitators and barriers. Generally, management of OUD in the ED varied significantly. Physician-level facilitators to treating opioid withdrawal with buprenorphine included: knowledge about OUD an7d buprenorphine, positive experiences with substitution therapy in the past, and the presence of physician champions. Systems-level facilitators included timely access to follow-up care and pre-printed order sets. Barriers included provider inexperience, lack of feedback on treatment effectiveness, limited time to counsel patients, and pressure to discharge patients quickly. Additional barriers included concerns about precipitating withdrawal, prescribing a chronic medication in acute care, and patient attitudes.

Conclusion

This study describes barriers and facilitators to addressing OUD and prescribing buprenorphine in a Canadian ED. These findings suggest a role for additional provider education, involvement of allied health professionals in counseling, and mentorship by physician champions in the department.

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Title: A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department
Authors: David Wiercigroch
Patricia Hoyeck
Hasan Sheikh
Jennifer Hulme
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Buprenorphine
Opioids
Opioids
Published in: BMC Emergency Medicine / Issue 1/2021
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-021-00443-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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