RT Journal Article
SR Electronic
T1 Buprenorphine–naloxone practice and attitudes in 22 Canadian emergency physician groups: a cross-sectional survey
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E864
OP E873
DO 10.9778/cmajo.20200190
VO 9
IS 3
A1 Andrew Kestler
A1 Janusz Kaczorowski
A1 Kathryn Dong
A1 Aaron M. Orkin
A1 Raoul Daoust
A1 Jessica Moe
A1 Kelsey Van Pelt
A1 Gary Andolfatto
A1 Michelle Klaiman
A1 Justin Yan
A1 Justin J. Koh
A1 Kathryn Crowder
A1 Devon Webster
A1 Paul Atkinson
A1 David Savage
A1 James Stempien
A1 Floyd Besserer
A1 Jason Wale
A1 Alice Lam
A1 Frank Scheuermeyer
YR 2021
UL http://www.cmajopen.ca/content/9/3/E864.abstract
AB Background: Buprenorphine–naloxone (BUP) initiation in emergency departments improves follow-up and survival among patients with opioid use disorder. We aimed to assess self-reported BUP-related practices and attitudes among emergency physicians.Methods: We designed a cross-sectional physician survey by adapting a validated questionnaire on opioid harm reduction practices, attitudes and barriers. We recruited physician leads from 6 Canadian provinces to administer surveys to the staff physicians in their emergency department groups between December 2018 and November 2019. We included academic and community non-locum emergency department staff physicians. We excluded responses from emergency department groups with response rates less than 50% to minimize nonresponse bias. Primary (BUP prescribing practices) and secondary (willingness and attitudes) outcomes were analyzed using descriptive statistics.Results: After excluding 1 group for low response (9/26 physicians), 652 of 798 (81.7%) physicians responded from 22 groups serving 34 emergency departments. Among respondents, 64.1% (95% confidence interval [CI] 60.4%–67.8%, emergency department group range 7.1%–100.0%) had prescribed BUP at least once in their career, 38.4% had prescribed it for home initiation and 24.8% prescribed it at least once a month. Overall, 68.9% (95% CI 65.3%–72.4%, emergency department group range 24.1%–97.6%) were willing to administer BUP, 64.2% felt it was a major responsibility and 37.1% felt they understood people who use drugs. Respondents most frequently rated lack of adequate training (58.2%) and lack of time (55.2%) as very important barriers to BUP initiation.Interpretation: Two-thirds of the emergency physicians surveyed prescribed BUP, although only one-quarter did so regularly and one-third prescribed it for home initiation; wide variation between emergency department groups existed. Strategies to increase BUP initiation must address physicians’ lack of time and training for BUP initiation and improve their understanding of people who use drugs.