Yale Researchers Advance Opioid Use Disorder Treatment in Emergency Departments
Yale University researchers, led by Gail D'Onofrio and David Fiellin, have been investigating the use of buprenorphine for opioid use disorder (OUD) in emergency departments (EDs) for over 15 years.
Their latest study, published in JAMA, examined the effectiveness of a seven-day extended-release injectable buprenorphine compared to the traditional daily sublingual version across 29 EDs in the United States.
Key Findings
The injectable extended-release buprenorphine was found to be as safe and effective as the daily sublingual version in engaging patients in follow-up treatment.
- At seven days, 40.5% of the extended-release group and 38.5% of the sublingual group were in treatment.
- At 30 days, these figures were 44% for extended-release and 45% for sublingual.
D'Onofrio stated that the emergency department is an optimal location to begin OUD treatment.
Extended-Release Advantages
The extended-release formulation offers a "direct to inject" method for patients exhibiting minimal opioid withdrawal (Clinical Opiate Withdrawal Scale, or COWS, score of 4-7). In contrast, sublingual dosing requires a COWS score of 8 or greater.
Patients receiving the extended-release injection reported reduced craving, decreased illicit opioid use, and higher satisfaction at the seven-day follow-up. Both buprenorphine types demonstrated infrequent instances of "precipitated withdrawal" (less than 1% of patients).
Addressing Treatment Barriers
OUD affects approximately 5.7 million individuals in the U.S., with a significant gap in treatment access, as only about 20% receive evidence-based care like buprenorphine. Traditional sublingual buprenorphine necessitates daily self-administration after pharmacy pick-up.
Extended-release buprenorphine, administered via injection and effective for seven days, has the potential to mitigate barriers such as transportation, pharmacy availability, and insurance authorization issues.
Study Details
The randomized clinical trial involved 2,000 adult patients with untreated OUD and a COWS score of 4 or higher. The study period ran from July 2020 to August 2024.
Participants were assigned to receive either a 24-milligram subcutaneous injection of extended-release buprenorphine or an initial dose of sublingual buprenorphine with a seven-day prescription. Both groups received referrals for continued medication management.
Conclusion
The study confirmed the comparable effectiveness of both buprenorphine formulations for engaging patients in treatment and noted low rates of precipitated withdrawal and reduced overdose incidents.
Other Yale authors included Kathryn Hawk, James Dziura, Patricia Owens, Shara Martel, Edouard Coupet Jr., E. Jennifer Edelman, and David Fiellin. Funding was provided by the National Institutes of Health (HEAL Initiative, National Institute on Drug Abuse) and Braeburn Pharmaceuticals.