Name
Capella University
NURS-FPX4025 Research and Evidence-Based Decision Making
Prof. Name
Date
Herring, A. A., Rosen, A. D., Samuels, E. A., Lin, C., Speener, M., Kaleekal, J., Shoptaw, S. J., Moulin, A. K., Campbell, A., Anderson, E., & Kalmin, M. M. (2024). Emergency department access to buprenorphine for opioid use disorder. Journal of American Medical Association Network Open, 7(1), e2353771.
DOI: https://doi.org/10.1001/jamanetworkopen.2023.53771
Published Date: 2024
Criteria | Review |
Study Type | Prospective multisite cohort study (observational, real-world implementation of low-threshold buprenorphine initiation in Emergency Departments (EDs). |
Level of Evidence | Level II (well-designed cohort study with prospective data collection; not randomized but multicenter, prospective, and methodologically precise). |
Methodology | Conducted in 7 California EDs (2021–2022) as part of the CA Bridge program. Adults with OUD were identified and offered buprenorphine (administered in ED, prescribed, or both) plus optional patient navigation. Main outcome: OUD treatment engagement at 30 days, evaluated through patient self-report and Electronic Health Records (EHR) documentation. Statistical analysis used modified Poisson regression with hospital site as a random effect. |
Credibility Factors | Published in a peer-reviewed, high-impact, credible journal. Multicenter design increases generalizability Strong data sources reported to the California Department of Health Care Services (EHR abstraction, structured surveys, validated follow-up). |
Importance of Selected Diagnosis | Opioid Use Disorder (OUD) remains a major United States (U.S) public health crisis (>80,000 overdose deaths in 2021). ED patients with OUD are at high risk of mortality and represent a critical access point for initiating life-saving treatment. Buprenorphine reduces overdose risk, improves quality of life, and lowers HIV/HCV transmission. |
Application in Workplace/Patient Population | Demonstrates the feasibility and effectiveness of ED-initiated buprenorphine in real-world, high-risk populations. Shows nearly 2x higher engagement in OUD treatment at 30 days when buprenorphine was initiated in the ED. Findings highlight the value of low-threshold, harm-reduction models with bundled interventions (buprenorphine + patient navigation). Relevant for EDs serving vulnerable populations with high rates of unstable housing, Medicaid enrollment, fentanyl/meth use, and mental health comorbidities. Supports the need for clinician training, and community strategies. Provides evidence to inform policy, hospital leadership, and frontline clinicians on expanding ED-based addiction care. |
Patient Name: Robbie Jameson
Clinical Concern Diagnosis: The patient presents with Opioid Use Disorder (OUD) due to heroin dependence and a heroin overdose. This results in malnutrition. She is at high risk for developing complications due to unstable vital signs and recent detoxification attempts.
Present Treatment: The patient is undergoing detoxification therapy for heroin use. She is being closely monitored to evaluate withdrawal symptoms, stabilize vital signs, and provide supportive care.
Care Regimen: The patient requires regular monitoring of vital signs, level of consciousness, and pertinent laboratory investigations to identify complications, nutritional deficiencies, and potential organ damage. The patient’s rehabilitation begins with supervised management of opioid dependence, accompanied by supportive care, hydration, and nutritional optimization. A coordinated recovery plan is critical, integrating interventions such as overdose prevention education, naloxone provision, and addiction medicine and behavioral health services.
Herring et al. (2024) evaluated the uptake and 30-day engagement of buprenorphine treatment among ED patients with OUD in a multisite cohort study. The researchers point out that 86% of patients received buprenorphine in the ED, administered, prescribed, or both, with the combination of administration plus prescription associated with the highest treatment engagement. Patients treated with buprenorphine were nearly twice as likely to remain engaged at 30 days compared with those who did not receive it. The article integrates low-threshold ED buprenorphine initiation, patient navigation, motivational interviewing, and harm-reduction strategies to improve OUD treatment engagement.
This can be especially critical to OUD populations with high rates of comorbid mental health conditions, unstable housing, and polysubstance use. The study emphasizes the role of patient navigators in supporting follow-up care, overcoming barriers, and coordinating outpatient services. The article is highly credible, as it is published in a reputable journal, employs a thorough methodology, includes a heterogeneous patient sample, and defines outcome measures. These findings can be applied in the clinical application of evidence-based practice, in EDs treating populations with high prevalence of unstable housing, comorbid mental health conditions, and polysubstance use. The study’s results inform clinical protocols aimed at enhancing buprenorphine uptake, engagement, and OUD care.
The findings by Herring et al. (2024) can be comprehensive to the ED, where individuals with OUD, such as Robbie Jameson, present in acute emergency. The study underlines that implementing low-threshold ED buprenorphine initiation, patient navigation, motivational interviewing, and harm-reduction strategies improves OUD treatment engagement. These interventions provide immediate clinical stabilization and facilitate linkage to constant treatment in patient populations experiencing acute medical instability, nutritional deficits, and repeated overdoses. For instance, administering buprenorphine during Robbie’s ED encounter with harm-reduction counseling and referral to supportive rehabilitation services addresses the immediate risk of overdose and the longer-term trajectory of recovery. This model promotes continuity of care for marginalized populations burdened by unstable housing and comorbid psychiatric illnesses.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814325
Herring, A. A., Rosen, A. D., Samuels, E. A., Lin, C., Speener, M., Kaleekal, J., Shoptaw, S. J., Moulin, A. K., Campbell, A., Anderson, E., & Kalmin, M. M. (2024). Emergency department access to buprenorphine for opioid use disorder. Journal of the American Medical Association Network Open, 7(1), e2353771. https://doi.org/10.1001/jamanetworkopen.2023.53771
