Emergency Department Access for Buprenorphine for Opioid Use Disorder

Andrew A. Herring
Allison D. Rosen
Elizabeth A. Samuels
Chunqing Lin
Melissa Speener
John Kaleekal
Steven J. Shoptaw
Aimee K. Moulin
Arianna Campbell
Erik Anderson
Mariah M. Kalmin
Peer-Reviewed Article
January 2024
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Buprenorphine treatment offered in emergency departments (EDs) is shown to improve treatment engagement for individuals with opioid use disorder.


Opioid overdose deaths in the United States increased 24% from 2020 to 2021. Urgent public health strategies are needed to respond to this growing crisis. Emergency departments (EDs) can play a role in opioid use disorder (OUD) treatment, particularly through the administration or prescription of medication-assisted treatments (MAT), such as buprenorphine.

Currently, few EDs have implemented programs to offer buprenorphine to people with OUD, despite well-documented clinical benefits. This study analyzes the ED patient outcomes of CA Bridge, a program that promotes low-threshold access to buprenorphine in seven California hospitals.


Eighty-five percent of 464 study participants received buprenorphine; 269 patients were administered buprenorphine in the ED and 339 received prescriptions. Patients treated with buprenorphine in the ED were twice as likely as the prescription-based treatment group to engage in OUD treatment 30 days following discharge. The CA Bridge model was identified as contributing to improved treatment engagement due to its low-threshold approach that eliminates traditional steps in buprenorphine initiation, such as intake evaluations and treatment readiness assessments. The model also promotes access to patient navigators, who follow up with patients after discharge and help them overcome social risk factors, including unstable housing.


The findings of this study suggest that EDs may serve as a critical access point for OUD patients interested in MAT options. Critically, patient advocates help patients identify barriers to treatment engagement and EDs can consider including these navigators in their approach to promote buprenorphine access.

Of note, patients who declined buprenorphine treatment were more likely to suffer from social risk conditions, such as unstable housing and comorbid behavioral health conditions. These patients require enhanced community-based referrals and services to address factors that could inhibit treatment uptake.

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