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Patient Perspectives on Offers of Buprenorphine in the Emergency Department.

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Τίτλος: Patient Perspectives on Offers of Buprenorphine in the Emergency Department.
Συγγραφείς: Jennings LK; Department of Emergency Medicine, Medical University of South Carolina, Charleston., Barth K; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston., Lane S; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston., Rafferty A; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston., Papa C; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston., Haynes L; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston., Sonne S; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston., McCowin H; Mercy Health, Youngstown, Ohio., Moschella P; Department of Medicine and Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville., Litwin AH; Department of Medicine and Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville., Manteuffel JJ; Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan., Brady K; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston., Moreland A; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston.
Πηγή: JAMA network open [JAMA Netw Open] 2026 Oct 01; Vol. 9 (10), pp. e2637671. Date of Electronic Publication: 2026 Oct 01.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
Imprint Name(s): Original Publication: Chicago, IL : American Medical Association, [2018]-
Ιατρικοί όροι (MeSH): Buprenorphine*/therapeutic use , Emergency Service, Hospital*/statistics & numerical data , Opioid-Related Disorders*/drug therapy , Opioid-Related Disorders*/psychology , Opiate Substitution Treatment*/psychology , Opiate Substitution Treatment*/methods , Narcotic Antagonists*/therapeutic use , Patient Acceptance of Health Care*/psychology , Patient Acceptance of Health Care*/statistics & numerical data, Humans ; Male ; Adult ; Female ; Middle Aged ; Qualitative Research ; Ohio ; Michigan
Περίληψη: Importance: Buprenorphine reduces mortality in opioid use disorder (OUD), and emergency department-initiated buprenorphine (EDIB) doubles 30-day treatment retention, yet many patients decline EDIB when offered. Patient-driven factors limiting uptake are not well characterized.
Objective: To identify factors associated with patients accepting or declining EDIB.
Design, Setting, and Participants: Convergent parallel mixed-methods qualitative study conducted from May 1 to December 31, 2023, with data analyses performed from March 2025 to April 2026, at 4 emergency departments within the National Drug Abuse Treatment Clinical Trials Network (CTN) in South Carolina, Michigan, and Ohio. Adult patients (aged ≥18 years) with OUD who were offered buprenorphine by clinical staff were eligible; prisoners and patients concurrently enrolled in other CTN trials of OUD treatment or overdose prevention were excluded.
Main Outcomes and Measures: The main outcomes were acceptance or declination of EDIB; validated measures of treatment readiness (Stages of Change Readiness and Treatment Engagement Scale [SOCRATES]), cultural mistrust, perceived discrimination, and social needs; and qualitative interview themes regarding reasons for accepting or declining buprenorphine.
Results: Eighty-two participants completed the study (median [IQR] age, 38 [31-53.5] years; 52 male [64%]). Overall, 19 participants (23%) declined buprenorphine. Among 54 participants who described reasons for accepting EDIB, motivators for accepting EDIB included assistance with opioid withdrawal (37 [69%]), desire to be substance free (21 [39%]), wanting to return to a "normal life" (15 [28%]), fear of overdose or death (13 [24%]), and caring for children (7 [13%]). Among 22 participants who described reasons for declining EDIB, barriers included concern about precipitated withdrawal or adverse effects (11 [50%]), not wanting to be physically dependent on buprenorphine (7 [32%]), and housing and logistical barriers (5 [23%]). SOCRATES treatment readiness (1-5 scale) was similar in patients who accepted (mean [SD] score, 4.11 [0.55]) and declined (mean [SD] score, 4.05 [0.50]) EDIB.
Conclusions and Relevance: In this mixed-methods qualitative study of adult ED patients with OUD who were offered buprenorphine, declination was driven less by low treatment readiness than by specific, addressable concerns: precipitated withdrawal, physical dependence, and housing and logistical barriers. Targeted interventions addressing these concerns may increase uptake of this life-saving treatment.
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Ann Emerg Med. 2019 May;73(5):481-487. (PMID: 30616926)
JAMA Psychiatry. 2021 Sep 1;78(9):979-993. (PMID: 34076676)
JAMA. 2026 Mar 17;335(11):948-960. (PMID: 41670966)
Am J Emerg Med. 2022 Aug;58:22-26. (PMID: 35623179)
JAMA Netw Open. 2023 Mar 1;6(3):e236108. (PMID: 36995717)
West J Emerg Med. 2022 Jun 29;23(5):684-692. (PMID: 36205682)
JAMA Netw Open. 2020 May 1;3(5):e204561. (PMID: 32391893)
N Engl J Med. 2018 Jul 5;379(1):1-4. (PMID: 29972748)
Fam Med. 1998 Jul-Aug;30(7):508-12. (PMID: 9669164)
Drug Alcohol Depend. 2021 Jul 1;224:108717. (PMID: 33985863)
J Am Coll Emerg Physicians Open. 2020 Oct 20;1(6):1712-1722. (PMID: 33392580)
Int J Drug Policy. 2024 Aug;130:104511. (PMID: 39003894)
JAMA Netw Open. 2025 Mar 03;8(3):e250137. (PMID: 40048167)
J Subst Use Addict Treat. 2025 Jan;168:209535. (PMID: 39369961)
Ann Emerg Med. 2021 Sep;78(3):434-442. (PMID: 34172303)
J Addict Dis. 2016;35(1):22-35. (PMID: 26467975)
J Subst Abuse Treat. 2022 Jul;138:108747. (PMID: 35248406)
J Subst Abuse Treat. 2022 Jul;138:108721. (PMID: 35067397)
Comput Inform Nurs. 2009 May-Jun;27(3):175-83. (PMID: 19411947)
JAMA Netw Open. 2023 Apr 3;6(4):e235439. (PMID: 37017967)
Addict Behav. 2021 Mar;114:106740. (PMID: 33352498)
JAMA Netw Open. 2024 Sep 3;7(9):e2435895. (PMID: 39331392)
Acad Emerg Med. 2020 Nov;27(11):1173-1182. (PMID: 32557932)
Subst Abus. 2021;42(3):245-254. (PMID: 34606426)
Drug Alcohol Depend. 2020 Nov 1;216:108270. (PMID: 32911132)
JAMA Netw Open. 2024 Jan 2;7(1):e2353771. (PMID: 38285444)
Pediatrics. 2010 Jul;126(1):e26-32. (PMID: 20595453)
Subst Abuse Rehabil. 2016 Jul 20;7:99-105. (PMID: 27499655)
J Health Psychol. 1997 Jul;2(3):335-51. (PMID: 22013026)
Health Aff (Millwood). 2013 Dec;32(12):2122-8. (PMID: 24301395)
Am J Drug Alcohol Abuse. 2024 May 3;50(3):391-400. (PMID: 38640497)
Am J Emerg Med. 2025 Mar;89:209-215. (PMID: 39742545)
Subst Use Addctn J. 2025 Oct;46(4):1064-1069. (PMID: 40183345)
JAMA. 2015 Apr 28;313(16):1636-44. (PMID: 25919527)
Drug Alcohol Depend. 2020 Feb 1;207:107799. (PMID: 31865058)
JAMA Netw Open. 2024 Sep 3;7(9):e2435857. (PMID: 39331399)
Acad Emerg Med. 2022 Aug;29(8):928-943. (PMID: 35426962)
J Adv Nurs. 2016 Dec;72(12):2954-2965. (PMID: 27221824)
J Subst Abuse Treat. 2021 Dec;131:108464. (PMID: 34098288)
BMJ. 2017 Apr 26;357:j1550. (PMID: 28446428)
Ann Intern Med. 2018 Aug 7;169(3):137-145. (PMID: 29913516)
N Engl J Med. 2020 Apr 2;382(14):1289-1290. (PMID: 32242351)
J Subst Abuse Treat. 2018 Nov;94:29-34. (PMID: 30243414)
Am Psychol. 1992 Sep;47(9):1102-14. (PMID: 1329589)
JAMA Netw Open. 2022 Mar 1;5(3):e223821. (PMID: 35319762)
West J Emerg Med. 2024 Sep;25(5):668-674. (PMID: 39319796)
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Substance Nomenclature: 40D3SCR4GZ (Buprenorphine)
0 (Narcotic Antagonists)
Entry Date(s): Date Created: 20261006 Date Completed: 20261006 Latest Revision: 20261009
Update Code: 20261009
PubMed Central ID: PMC13643581
DOI: 10.1001/jamanetworkopen.2026.37671
PMID: 42837150
Βάση Δεδομένων: MEDLINE
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  Data: Patient Perspectives on Offers of Buprenorphine in the Emergency Department.
– Name: Author
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  Data: <searchLink fieldCode="AU" term="%22Jennings+LK%22">Jennings LK</searchLink>; Department of Emergency Medicine, Medical University of South Carolina, Charleston.<br /><searchLink fieldCode="AU" term="%22Barth+K%22">Barth K</searchLink>; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston.<br /><searchLink fieldCode="AU" term="%22Lane+S%22">Lane S</searchLink>; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston.<br /><searchLink fieldCode="AU" term="%22Rafferty+A%22">Rafferty A</searchLink>; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston.<br /><searchLink fieldCode="AU" term="%22Papa+C%22">Papa C</searchLink>; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston.<br /><searchLink fieldCode="AU" term="%22Haynes+L%22">Haynes L</searchLink>; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston.<br /><searchLink fieldCode="AU" term="%22Sonne+S%22">Sonne S</searchLink>; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston.<br /><searchLink fieldCode="AU" term="%22McCowin+H%22">McCowin H</searchLink>; Mercy Health, Youngstown, Ohio.<br /><searchLink fieldCode="AU" term="%22Moschella+P%22">Moschella P</searchLink>; Department of Medicine and Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville.<br /><searchLink fieldCode="AU" term="%22Litwin+AH%22">Litwin AH</searchLink>; Department of Medicine and Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville.<br /><searchLink fieldCode="AU" term="%22Manteuffel+JJ%22">Manteuffel JJ</searchLink>; Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan.<br /><searchLink fieldCode="AU" term="%22Brady+K%22">Brady K</searchLink>; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston.<br /><searchLink fieldCode="AU" term="%22Moreland+A%22">Moreland A</searchLink>; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston.
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  Data: <i>Original Publication</i>: Chicago, IL : American Medical Association, [2018]-
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  Data: <searchLink fieldCode="MM" term="%22Buprenorphine%22">Buprenorphine*</searchLink>/<searchLink fieldCode="MM" term="%22Buprenorphine+therapeutic+use%22">therapeutic use</searchLink> <br /><searchLink fieldCode="MM" term="%22Emergency+Service%2C+Hospital%22">Emergency Service, Hospital*</searchLink>/<searchLink fieldCode="MM" term="%22Emergency+Service%2C+Hospital+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Opioid-Related+Disorders%22">Opioid-Related Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Opioid-Related+Disorders+drug+therapy%22">drug therapy</searchLink> <br /><searchLink fieldCode="MM" term="%22Opioid-Related+Disorders%22">Opioid-Related Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Opioid-Related+Disorders+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Opiate+Substitution+Treatment%22">Opiate Substitution Treatment*</searchLink>/<searchLink fieldCode="MM" term="%22Opiate+Substitution+Treatment+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Opiate+Substitution+Treatment%22">Opiate Substitution Treatment*</searchLink>/<searchLink fieldCode="MM" term="%22Opiate+Substitution+Treatment+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Narcotic+Antagonists%22">Narcotic Antagonists*</searchLink>/<searchLink fieldCode="MM" term="%22Narcotic+Antagonists+therapeutic+use%22">therapeutic use</searchLink> <br /><searchLink fieldCode="MM" term="%22Patient+Acceptance+of+Health+Care%22">Patient Acceptance of Health Care*</searchLink>/<searchLink fieldCode="MM" term="%22Patient+Acceptance+of+Health+Care+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Patient+Acceptance+of+Health+Care%22">Patient Acceptance of Health Care*</searchLink>/<searchLink fieldCode="MM" term="%22Patient+Acceptance+of+Health+Care+statistics+%26+numerical+data%22">statistics & numerical data</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Qualitative+Research%22">Qualitative Research</searchLink> ; <searchLink fieldCode="MH" term="%22Ohio%22">Ohio</searchLink> ; <searchLink fieldCode="MH" term="%22Michigan%22">Michigan</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Importance: Buprenorphine reduces mortality in opioid use disorder (OUD), and emergency department-initiated buprenorphine (EDIB) doubles 30-day treatment retention, yet many patients decline EDIB when offered. Patient-driven factors limiting uptake are not well characterized.<br />Objective: To identify factors associated with patients accepting or declining EDIB.<br />Design, Setting, and Participants: Convergent parallel mixed-methods qualitative study conducted from May 1 to December 31, 2023, with data analyses performed from March 2025 to April 2026, at 4 emergency departments within the National Drug Abuse Treatment Clinical Trials Network (CTN) in South Carolina, Michigan, and Ohio. Adult patients (aged ≥18 years) with OUD who were offered buprenorphine by clinical staff were eligible; prisoners and patients concurrently enrolled in other CTN trials of OUD treatment or overdose prevention were excluded.<br />Main Outcomes and Measures: The main outcomes were acceptance or declination of EDIB; validated measures of treatment readiness (Stages of Change Readiness and Treatment Engagement Scale [SOCRATES]), cultural mistrust, perceived discrimination, and social needs; and qualitative interview themes regarding reasons for accepting or declining buprenorphine.<br />Results: Eighty-two participants completed the study (median [IQR] age, 38 [31-53.5] years; 52 male [64%]). Overall, 19 participants (23%) declined buprenorphine. Among 54 participants who described reasons for accepting EDIB, motivators for accepting EDIB included assistance with opioid withdrawal (37 [69%]), desire to be substance free (21 [39%]), wanting to return to a "normal life" (15 [28%]), fear of overdose or death (13 [24%]), and caring for children (7 [13%]). Among 22 participants who described reasons for declining EDIB, barriers included concern about precipitated withdrawal or adverse effects (11 [50%]), not wanting to be physically dependent on buprenorphine (7 [32%]), and housing and logistical barriers (5 [23%]). SOCRATES treatment readiness (1-5 scale) was similar in patients who accepted (mean [SD] score, 4.11 [0.55]) and declined (mean [SD] score, 4.05 [0.50]) EDIB.<br />Conclusions and Relevance: In this mixed-methods qualitative study of adult ED patients with OUD who were offered buprenorphine, declination was driven less by low treatment readiness than by specific, addressable concerns: precipitated withdrawal, physical dependence, and housing and logistical barriers. Targeted interventions addressing these concerns may increase uptake of this life-saving treatment.
– Name: Ref
  Label: References
  Group: RefInfo
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  Data: <i>Date Created: </i>20261006 <i>Date Completed: </i>20261006 <i>Latest Revision: </i>20261009
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        Text: English
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        Type: general
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      – SubjectFull: Adult
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      – SubjectFull: Buprenorphine therapeutic use
        Type: general
      – SubjectFull: Emergency Service, Hospital statistics & numerical data
        Type: general
      – SubjectFull: Opioid-Related Disorders drug therapy
        Type: general
      – SubjectFull: Opioid-Related Disorders psychology
        Type: general
      – SubjectFull: Opiate Substitution Treatment psychology
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      – SubjectFull: Opiate Substitution Treatment methods
        Type: general
      – SubjectFull: Narcotic Antagonists therapeutic use
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      – SubjectFull: Patient Acceptance of Health Care statistics & numerical data
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      – TitleFull: Patient Perspectives on Offers of Buprenorphine in the Emergency Department.
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              Text: 2026 Oct 01
              Type: published
              Y: 2026
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