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ED-Initiated Buprenorphine for Opioid Use Disorder (Recording)


ED-Initiated Buprenorphine for Opioid Use Disorder (Recording) Banner

  • Overview
  • Faculty
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Date & Location
Friday, July 7, 2023, 12:00 AM - Monday, July 6, 2026, 11:59 PM, On Demand

Overview
This webinar focuses on the crucial role of the emergency department (ED) in recognizing and treating opioid use disorder (OUD) patients with evidence-based medications for addiction treatment. Overall, the opioid epidemic intertwined with the COVID-19 pandemic has greatly escalated the need to mitigate the morbidity and mortality associated with the rising rate of fentanyl use. Gail D’Onofrio, MD, discusses her pioneering work in creating the evidence for initiating ED buprenorphine treatment with ED patients presenting with opioid use disorder. Topics covered will include: Data supporting the use of buprenorphine in the ED setting as well as the consequences of not initiating treatment, barriers to implementation of ED buprenorphine, and components of successful integration of an ED program with community partnerships. Dr. D’Onofrio also presents current research by emergency physicians regarding innovative strategies such as high-dose buprenorphine inductions and use of extended release 7-day formulation of buprenorphine.

Registration

  Release Date: July 07, 2023
  Expiration Date: July 06, 2026
  Estimated Time to Complete: 1.5 hours
  Registration Fee: FREE
 *Originally recorded 06/30/2022.

View more DEA MATE resources and training accredited by Stanford CME at https://med.stanford.edu/cme/dea.html


Credits
AMA PRA Category 1 Credits™ (1.50 hours), ANCC Contact Hours (1.50 hours), APA Continuing Education credits (1.50 hours), Non-Physician Participation Credit (1.50 hours)

Target Audience
Specialties - Psychiatry & Behavioral Sciences
Professions - Advance Practice Nurse (APN), Fellow/Resident, Non-Physician, Nurse, Physician, Psychologist, Registered Nurse (RN)

Objectives
At the conclusion of this activity, learners should be able to:

  1. Evaluate at least two outcomes for opioid use disorder in patients receiving buprenorphine through the Emergency Department and discuss supporting evidence.
  2. Identify at least two barriers and two solutions to initiating buprenorphine in the Emergency Department.
  3. Apply at least two harm reduction strategies and components of the buprenorphine integration pathway.
  4. Propose at least two innovative solutions for buprenorphine induction in the ED including different formulations of buprenorphine and high dose strategies.

Accreditation

In support of improving patient care, this activity has been planned and implemented by Stanford Medicine and the Northwest Addiction Technology Transfer Center (ATTC). Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 
 
Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 1.50 AMA PRA Category 1 CreditsTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

American Nurses Credentialing Center (ANCC) 
Stanford Medicine designates this Enduring Material for a maximum of 1.5 ANCC contact hours.  

American Psychological Association (APA) 
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibly for the content of the programs.


Additional Information

Accessibility Statement
 Stanford University School of Medicine is committed to ensuring that its programs, services, goods and facilities are accessible to individuals with disabilities as specified under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Amendments Act of 2008.  If you have needs that require accommodations, please contact the CME Conference Coordinator.

Cultural and Linguistic Competency
The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: https://laneguides.stanford.edu/multicultural-health

Bibliography/Works Cited

Amato, L., Minozzi, S., Davoli, M., & Vecchi, S. (2011). Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. The Cochrane database of systematic reviews, (10), CD004147. https://doi.org/10.1002/14651858.CD004147.pub4

Botticelli, M. P., & Koh, H. K. (2016). Changing the Language of Addiction. JAMA, 316(13), 1361–1362. https://doi.org/10.1001/jama.2016.11874

Busch, S. H., Fiellin, D. A., Chawarski, M. C., Owens, P. H., Pantalon, M. V., Hawk, K., Bernstein, S. L., O'Connor, P. G., & D'Onofrio, G. (2017). Cost-effectiveness of emergency department-initiated treatment for opioid dependence. Addiction (Abingdon, England), 112(11), 2002–2010. https://doi.org/10.1111/add.13900

Comer, S., et al. (2015). The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. American Society of Addiction Medicine. https://www.sandhillscenter.org/uploads/asamnationalpracticeguidelinesupplement.pdf
 
D'Onofrio, G., Hawk, K. F., Herring, A. A., Perrone, J., Cowan, E., McCormack, R. P., Dziura, J., Taylor, R. A., Coupet, E., Edelman, E. J., Pantalon, M. V., Owens, P. H., Martel, S. H., O'Connor, P. G., Van Veldhuisen, P., DeVogel, N., Huntley, K., Murphy, S. M., Lofwall, M. R., Walsh, S. L., … Fiellin, D. A. (2021). The design and conduct of a randomized clinical trial comparing emergency department initiation of sublingual versus a 7-day extended-release injection formulation of buprenorphine for opioid use disorder: Project ED Innovation. Contemporary clinical trials, 104, 106359. https://doi.org/10.1016/j.cct.2021.106359

D'Onofrio, G., Melnick, E. R., & Hawk, K. F. (2021). Improve Access to Care for Opioid Use Disorder: A Call to Eliminate the X-Waiver Requirement Now. Annals of emergency medicine, 78(2), 220–222. https://doi.org/10.1016/j.annemergmed.2021.03.023

D'Onofrio, G., O'Connor, P. G., Pantalon, M. V., Chawarski, M. C., Busch, S. H., Owens, P. H., Bernstein, S. L., & Fiellin, D. A. (2015). Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA, 313(16), 1636–1644. https://doi.org/10.1001/jama.2015.3474

Friedman, J., Godvin, M., Shover, C. L., Gone, J. P., Hansen, H., & Schriger, D. L. (2022). Trends in Drug Overdose Deaths Among US Adolescents, January 2010 to June 2021. JAMA, 327(14), 1398–1400. https://doi.org/10.1001/jama.2022.2847

Hawk, K. F., D'Onofrio, G., Chawarski, M. C., O'Connor, P. G., Cowan, E., Lyons, M. S., Richardson, L., Rothman, R. E., Whiteside, L. K., Owens, P. H., Martel, S. H., Coupet, E., Jr, Pantalon, M., Curry, L., Fiellin, D. A., & Edelman, E. J. (2020). Barriers and Facilitators to Clinician Readiness to Provide Emergency Department-Initiated Buprenorphine. JAMA network open, 3(5), e204561. https://doi.org/10.1001/jamanetworkopen.2020.4561

Hawk, K., Hoppe, J., Ketcham, E., LaPietra, A., Moulin, A., Nelson, L., Schwarz, E., Shahid, S., Stader, D., Wilson, M. P., & D'Onofrio, G. (2021). Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department. Annals of emergency medicine, 78(3), 434–442. https://doi.org/10.1016/j.annemergmed.2021.04.023

Hawk, K., McCormack, R., Edelman, E. J., Coupet, E., Jr, Toledo, N., Gauthier, P., Rotrosen, J., Chawarski, M., Martel, S., Owens, P., Pantalon, M. V., O'Connor, P., Whiteside, L. K., Cowan, E., Richardson, L. D., Lyons, M. S., Rothman, R., Marsch, L., Fiellin, D. A., & D'Onofrio, G. (2022). Perspectives About Emergency Department Care Encounters Among Adults With Opioid Use Disorder. JAMA network open, 5(1), e2144955. https://doi.org/10.1001/jamanetworkopen.2021.44955

Herring, A. A., Vosooghi, A. A., Luftig, J., Anderson, E. S., Zhao, X., Dziura, J., Hawk, K. F., McCormack, R. P., Saxon, A., & D'Onofrio, G. (2021). High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder. JAMA network open, 4(7), e2117128. https://doi.org/10.1001/jamanetworkopen.2021.17128

Holland, K. M., Jones, C., Vivolo-Kantor, A. M., Idaikkadar, N., Zwald, M., Hoots, B., Yard, E., D'Inverno, A., Swedo, E., Chen, M. S., Petrosky, E., Board, A., Martinez, P., Stone, D. M., Law, R., Coletta, M. A., Adjemian, J., Thomas, C., Puddy, R. W., Peacock, G., … Houry, D. (2021). Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic. JAMA psychiatry, 78(4), 372–379. https://doi.org/10.1001/jamapsychiatry.2020.4402

Larochelle, M. R., Bernson, D., Land, T., Stopka, T. J., Wang, N., Xuan, Z., Bagley, S. M., Liebschutz, J. M., & Walley, A. Y. (2018). Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Annals of internal medicine, 169(3), 137–145. https://doi.org/10.7326/M17-3107

Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. The Cochrane database of systematic reviews, (2), CD002207. https://doi.org/10.1002/14651858.CD002207.pub4

McCormack, R. P., Rotrosen, J., Gauthier, P., D'Onofrio, G., Fiellin, D. A., Marsch, L. A., Novo, P., Liu, D., Edelman, E. J., Farkas, S., Matthews, A. G., Mulatya, C., Salazar, D., Wolff, J., Knight, R., Goodman, W., & Hawk, K. (2021). Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study. Addiction science & clinical practice, 16(1), 16. https://doi.org/10.1186/s13722-021-00224-y

Melnick, E. R., Nath, B., Dziura, J. D., Casey, M. F., Jeffery, M. M., Paek, H., Soares, W. E., 3rd, Hoppe, J. A., Rajeevan, H., Li, F., Skains, R. M., Walter, L. A., Patel, M. D., Chari, S. V., Platts-Mills, T. F., Hess, E. P., & D'Onofrio, G. (2022). User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial. BMJ (Clinical research ed.), 377, e069271. https://doi.org/10.1136/bmj-2021-069271

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication-Assisted Treatment for Opioid Use Disorder, Mancher, M., & Leshner, A. I. (Eds.). (2019). Medications for Opioid Use Disorder Save Lives. National Academies Press (US).

National Institute on Drug Abuse. (2023). Initiating Buprenorphine Treatment in the Emergency Department. National Institutes of Health. https://nida.nih.gov/nidamed-medical-health-professionals/discipline-specific-resources/emergency-physicians-first-responders/initiating-buprenorphine-treatment-in-emergency-department

National Survey on Drug Use and Health. (2021). 2020 NSDUH Annual National Report. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2020-nsduh-annual-national-report

National Vital Statistics System. (2021). Provisional Drug Overdose Death Counts. Centers for Disease Control and Prevention, National Center for Health Statistics. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Rhee, T. G., D'Onofrio, G., & Fiellin, D. A. (2020). Trends in the Use of Buprenorphine in US Emergency Departments, 2002-2017. JAMA network open, 3(10), e2021209. https://doi.org/10.1001/jamanetworkopen.2020.21209

Rosado, J., Walsh, S. L., Bigelow, G. E., & Strain, E. C. (2007). Sublingual buprenorphine/naloxone precipitated withdrawal in subjects maintained on 100mg of daily methadone. Drug and alcohol dependence, 90(2-3), 261–269. https://doi.org/10.1016/j.drugalcdep.2007.04.006

Substance Abuse and Mental Health Services Administration. (2021). HHS Releases New Buprenorphine Practice Guidelines, Expanding Access to Treatment for Opioid Use Disorder. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/newsroom/press-announcements/202104270930

Substance Abuse and Mental Health Services Administration. (2023). Waiver Elimination (MAT Act). Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medications-substance-use-disorders/waiver-elimination-mat-act

Substance Abuse and Mental Health Services Administration, & Drug Abuse Warning Network (DAWN). (2021). Preliminary Findings from Drug-Related Emergency Department Visits, 2021. Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP22-07-03-001.pdf

Sullivan, R. W., Szczesniak, L. M., & Wojcik, S. M. (2021). Bridge clinic buprenorphine program decreases emergency department visits. Journal of substance abuse treatment, 130, 108410. https://doi.org/10.1016/j.jsat.2021.108410

Yale Department of Emergency Medicine, The. (2023). ED-Initiated Buprenorphine. Yale School of Medicine. https://medicine.yale.edu/edbup/ 

Yeboah-Sampong, S., Weber, E., & Friedman, S. (2021). EMERGENCY: Hospitals are Violating Federal Laws by Denying Required Care for Substance Use Disorders in Emergency Departments. Legal Action Center. https://www.lac.org/assets/files/LAC-Report-Final-7.19.21.pdf

For CME general questions, please contact 
 
   Email: [email protected]



Mitigation of Relevant Financial Relationships


Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education.

At the time the content was created, there were no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity. 



Member Information
Role in activity
Nature of Relationship(s) / Name of Ineligible Company(s)
Keith Humphreys, PhD
Professor
Stanford University
Course Director
Nothing to disclose
Gail D’Onofrio, MD
Albert E. Kent Professor of Emergency Medicine, Professor of Medicine and Public Health
Yale School of Medicine
Faculty
Faculty Photos
Anna Lembke, MD
Associate Professor, Psychiatry and Behavioral Sciences; Associate Professor (By courtesy), Anesthesiology, Perioperative and Pain Medicine
Stanford Hospital & Clinics
Planner
Nothing to disclose
Tanya R Sorell, NP
Associate Professor
Rush Medical School
Planner
Ryelee A Vest
Assistant Clinical Research Coordinator
Stanford University School of Medicine
Planner
Nothing to disclose

ED-Initiated Buprenorphine for Opioid Use Disorder (Recording)
INSTRUCTIONS:  Click the Launch YouTube button to watch the video on YouTube. Next, click the Attestation button. Attest to your participation, view results, and complete the evaluation. After successful completion, your credit transcript will be available to view and download immediately in MY CE portal. 

Can’t find the evaluation? Click the MY CE button and select the Evaluation and Certificates tile. Select the Complete Evaluation button associated with the activity. 
Launch YouTube Attestation

 

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