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Increasing Buprenorphine Prescribing in California’s Emergency Departments

Amidst a surge in opioid-related fatalities in the United States, efforts have intensified nationwide to empower emergency clinicians to prescribe buprenorphine, a medication designed to manage opioid use disorder. A recent study published in JAMA by researchers at UCLA Health sheds light on the progress and effectiveness of these initiatives specifically in California.

The landscape of opioid-related emergency department (ED) visits, hospitalizations, and deaths has dramatically worsened since 1999, culminating in a public health emergency being declared in 2024. The established standard for treating opioid use disorder combines psychotherapy with medication options, including methadone, buprenorphine, or naltrexone. Buprenorphine is particularly notable for its ability to attach to brain opioid receptors, alleviating cravings and withdrawal without causing the exhilarating highs associated with other opioids. In 2019, BRIDGE, an organization focused on enhancing access to treatment for substance use disorders, launched a comprehensive initiative across California aimed at encouraging emergency departments to prescribe buprenorphine and facilitate connections to addiction treatment services.

Dr. Annette Dekker, an assistant professor in the Department of Emergency Medicine at UCLA and the study’s lead author, remarked on the unique role EDs play in patient care, stating, “For many individuals using opioids, the emergency department may serve as their primary point of contact within the healthcare system, presenting a significant opportunity to effect change. We initiate buprenorphine treatment during their ED visit, but there is limited insight into their long-term adherence to the medication, motivating us to explore patient journeys post-initiation.”

To gain insights, researchers evaluated data regarding buprenorphine prescriptions from the California Controlled Substance Utilization Review and Evaluation System spanning 2017 to 2022.

The findings revealed a noteworthy increase in emergency medicine clinicians prescribing buprenorphine, climbing from 2% to 16% among all buprenorphine prescribers in California. Additionally, prescriptions started in the ED for buprenorphine rose from 0.1% to 5%. “This significant escalation in prescribing practices over the past five years indicates that our initiatives are yielding positive results,” noted Dekker. The data also indicated that approximately one-third of patients were securing a second buprenorphine prescription within 40 days of their initial prescription from the ED, while one in nine patients maintained ongoing prescriptions within a year.

Encouraged by these developments, Dr. Dekker expressed, “While the results are promising, I am concerned about the declining percentage of patients linked to ongoing treatment. This highlights the necessity for continued investment in solidifying connections to outpatient care directly from the emergency department, exemplified by programs like BRIDGE, alongside enhancing outpatient treatment capabilities to ensure sustained care.”

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