Initiation of buprenorphine in the emergency department or emergency out-of-hospital setting: A mixed-methods systematic review
Bibliographic record
Abstract
People who use substances increasingly access healthcare primarily through emergency medical services (EMS) and emergency departments (EDs). To meet the needs of these patients, EMS and EDs have become access points for medications for opioid use disorder (OUD), specifically buprenorphine. This systematic review aimed to quantify the efficacy of these programs, examining retention in treatment for OUD, rates of re-presentation to ED or EMS, and rates of precipitated withdrawal, as well as summarise clinician and patient perspectives on buprenorphine initiation in these settings. This review considered studies including patients with OUD receiving, and providers initiating, buprenorphine in an ED or EMS setting. A convergent, segregated approach to mixed-methods review was used as recommended by the Joanna Briggs Institute. A search was conducted of MEDLINE, CINAHL, EMBASE, and the Cochrane Library. Where relevant, meta-analyses of odds ratios and proportions were conducted. In both randomised (OR 5.97, 95 %CI 2.52–14.14, 227 participants, I 2 16.93 %) and observational (OR 4.28, 95 %CI 2.45–7.48, 779 participants, I 2 66.97 %) research, buprenorphine in the ED or EMS setting was associated with increased odds of treatment engagement at 30 days. Rates of retention in treatment varied across measured time points, from 77 % (95 %CI 74–80 %, 763 participants, I 2 0.01 %) within 24 h, to 35 % (95 %CI 29–40 %) at 12 months. A low rate of precipitated withdrawal was reported (0.00 %, 95 %CI 0.00–1.00 %, 851 participants, I 2 0.00 %). Clinicians and patients were generally supportive of ED-initiated buprenorphine, while identifying the initiation buprenorphine as one component of a longitudinal care path for people with OUD. Patients valued clinicians engaging in shared decision-making, while clinicians identified the environment of the ED often made this challenging. The initiation of buprenorphine in the ED setting is associated with higher odds of short and medium-term treatment engagement. Further research is required into EMS-initiated buprenorphine, as well as patient perspectives of ED- and EMS-initiated buprenorphine.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.060 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.013 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".