Facilitators of and barriers to buprenorphine initiation in the emergency department: a scoping review.

Buprenorphine initiation in the Emergency Department (ED) has been hailed as an evidence-based strategy to mitigate the opioid overdose crisis, but its implementation has been limited. This scoping review synthesizes barriers and facilitators to buprenorphine initiation in the ED, and uses the Consolidated Framework for Implementation Research and a critical lens to analyze the literature. Results demonstrate an immense effort across the U.S. and Canada to implement ED-initiated buprenorphine. Facilitators include multidisciplinary addiction teams and co-located, low-barrier, harm reduction-informed services to support transitions. Barriers include a failure to address structural stigma, client complexity, and an increasingly toxic drug supply. The literature also misses the opportunity to include the perspectives of service users, health administrators, and learners. Increased coordination of implementation efforts, and a shift to equitable and inclusive opioid agonist therapy initiation pathways are needed across the U.S. and Canada.
Competing Interests: NB has received research grant support from the Canadian College of Family Physicians, Womenmind, the Academic Health Sciences Innovation Fund, and salary support from U.S. National Institute on Drug Abuse (NIDA) grant R25-DA037756 outside of the submitted work. She has received honoraria for creation and delivery of continuing professional development activities, some related to opioid agonist therapy, from the Centre for Addiction and Mental Health and the Ontario College of Family Physicians. CK has received funding from the Ministry of Health and Long Term Care's AFP Innovation Fund. EG has received a research stipend from the Comprehensive Research Experience for Medical Students (CREMS) through the University of Toronto Temerty School of Medicine. ZF has received support from BioTalent Canada–Student Work Placement Program. DS reports remuneration from the Canadian Medical Protective Agency for expert testimony. ES has received funding from the Agency for Healthcare Research and Quality 1K08HS025701. Outside of the submitted work, ES reports grant funding from NIDA and the RIZE foundation. BP, CB, CS, MK, KK, and TR report no conflicts of interest.
(© 2024 The Authors.)