Patient acceptance of emergency department-initiated buprenorphine and reasons for declining

Background

Medication for Opioid Use Disorder (MOUD) reduces morbidity and mortality for patients with opioid use disorder (OUD). Emergency department-initiated buprenorphine (EDIB) doubles retention in treatment at 30 days compared to outpatient referral alone. Little is known about acceptance rates of EDIB and reasons why patients decline this life-saving intervention.

Objectives

The aim of this study was to quantify the number of patients who initiate and decline buprenorphine in the ED and determine reasons for declination.

Methods

Seven SC EDs implemented EDIB programs that included ED-based peer recovery specialists (PRSs) to provide a brief intervention and assist with referral to outpatient treatment. The PRSs recorded patient interactions in a database including medical eligibility, if EDIB was provided, and the reason(s) why eligible patients declined EDIB. All eligible EDIB patients were entered in the PRS database and included in the study. Reasons for declining buprenorphine in eligible patients were analyzed with both fixed and free-text response options.

Results

A total of 2205 patients were eligible for EDIB. Of those, 963 (43.6 %) patients accepted buprenorphine and 1242 (56.3 %) declined. The most common reasons for declination were 1) the “patient preferring non-MOUD treatment” (53.4 %), 2) “Not ready/would like to think about it and/or check with other treatment providers or case workers” (16.7 %).

Conclusions

Over half of patients with OUD who were eligible for EDIB declined treatment, with the most common reason being preference for non-MOUD treatment. Given the success of MOUD for treatment of OUD, this topic requires further exploration.