Expanding Access to OAT Initiation: Buprenorphine/Naloxone Rapid Access in Emergency Departments

PI: Janusz Kaczorowski (Centre de recherche du CHUM, QC)

Leadership Group: Aaron Orkin (Mount Sinai Hospital, ON); Andrew Kestler (University of British Columbia, BC); Kathryn Dong (University of Alberta, AB)

 The purpose of this thematic area is to enhance access to opioid agonist treatment (OAT) in emergency departments by reviewing the current landscape of this intervention, and developing educational resources to address the gaps, attitudes, knowledge, and skills of emergency physicians. *Results from activities 1-3 will be used to contribute to the development of activities 4-5.

Emergency Department Initiation of Opioid Agonist Treatment for Patients with Opioid Dependence: A Rapid Systematic Review

Given the recent interest in OAT initiation in emergency departments to address the opioid crisis in Canada, there is a need to identify and synthesize the existing literature to better understand this intervention. Undertaking this systematic review will provide critical information to audiences engaged in research, practice, and policy.

Survey of Emergency Physician’s Attitudes toward Initiating Opioid Agonist Treatment

While the opioid crisis is a complex issue, there are a number of steps emergency physicians can take to assist patients at risk, including initiating OAT in the emergency department. However, the level of comfort and willingness of emergency physicians to initiate OAT remains unclear. A survey will be administered targeting emergency physicians across British Columbia, Alberta, Ontario, and Quebec. Objectives include:

  • Identify emergency physicians’ attitudes towards initiating OAT in emergency departments, identify current prescribing patterns amongst emergency physicians (i.e. frequency of prescribing buprenorphine/naloxone), identify emergency physicians’ perceived barriers and facilitators in initiating OAT, identify emergency physicians’ awareness of resources (published guidelines, accessing addictions specialist, etc.) to ensure appropriate management and provision of OAT,
  • The results will be used to identify sites to be selected for the focus groups in activity 3 (see below)

Expanding access to OAT in emergency departments: Phone Interviews

Differing views, attitudes and accessibility of OAT have resulted in different stages of implementation across Canadian emergency departments. To support and facilitate emergency departments in their implementation process, this activity proposes to conduct phone interviews withemergency physicians across Canada who are interested in OAT implementation The phone interviews will include discussions from the preliminary results from activity 2. After all the phone interviews are complete, the results will be used to describe the current context surrounding ED OAT implementation nationally, including key recommendations for consideration and to create an implementation resource for other emergency departments interested in expanding access to OAT.

Implementation toolkit/ guide *activity to be further developed

The results from activities 1-3 will be used to inform the development of this toolkit/ guide. The goal of the toolkit/ guide is to provide resources for emergency departments and physicians to efficiently and successfully expand access to OAT.

Knowledge mobilization *activity to be further developed

The data collected in the projects described above and the implementation toolkit/ guide will be disseminated to service providers and key stakeholders to expand access to OAT and to train the next generation of providers.