2023 MTF/SAEMF Toxicology Research Grant - $20,000

"Efficacy and Incidence of Adverse Events of High Dose Buprenorphine for MOUD in the ED"

In 2020, according to the Centers for Disease Control and Prevention (CDC), nearly 69,000 people died from an opioid overdose in the United States (U.S.). Both buprenorphine and methadone reduce mortality due to opioid overdose. The total number of emergency department (ED) visits related to opioid use in the U.S. grew from 2005 to 2017, with the overall rate increase from 89.1 to 249.1 per 100,000 population. Due to the prevalence of opioid use disorder (OUD) within many EDs across the country, initiating medications for opioid use disorder (MOUD) using buprenorphine in the ED provides the opportunity to reach many patients, particularly those who may not successfully attend an initial outpatient appointment. The current recommended dosing regimen of 2 to 4 mg every 2 hours to a maximum dose of 12 mg for induction is impractical in the ED and carries a high risk of precipitated opioid withdrawal if initiated prior to the development of moderate opioid withdrawal and higher probability of falling out of treatment due to the length and inefficacy of the method. Because buprenorphine has a higher binding affinity for the mu-opioid receptors than full opioid agonists, initiating treatment with a high dose of buprenorphine to replace opioid agonists bound to mu-opioid receptors should prevent precipitated withdrawal in those with early, mild opioid withdrawal.

At our institution high dose buprenorphine use in early withdrawal is a common, guideline-driven practice, although there is limited published literature. The goal of this study is to contribute safety and efficacy data regarding high dose buprenorphine initiation within the ED, particularly in OUD patients in mild or no withdrawal (COWS<8). The use of high-dose buprenorphine as MOUD for patients within the ED appears to be safe, decrease length of stay, and make MOUD more accessible.