57EMF X-Waiver Training for Resident Physicians Increases Emergency Department Buprenorphine Delivery: An Implementation Science Evaluation

Abstract

Study Objectives: Despite a growing awareness of the opiate epidemic, access to comprehensive care for opiate use disorder (OUD) remains a challenge Buprenorphine administration in acute opioid withdrawal can lead to improved outcomes for patients with OUD, increased follow up with addiction treatment, reduced illicit drug use and lower medical system costs for drug related ED visits Emergency providers may serve to provide an induction to medication-assisted therapy (MAT), decreasing the risk of use after discharge, and referring patients to outpatient MAT providers However, across the spectrum of practice, there continue to be barriers to utilization of buprenorphine, including fears of precipitating withdrawal, fears of diversion or overdose, and beliefs that additional licenses are needed to offer treatment Residents in training have been shown to carry forward practices learned in residency;thus, targeting educational interventions to these emerging physicians has the potential to affect downstream practice patterns and improve patient care Methods: LAC+USC is an urban, tertiary care facility with a large emergency medicine residency We conducted X-waiver training for all emergency residents, which concluded in January of 2020 We examined the number of residents who obtained their X-waiver following the training and changes in patient care including the number of patients dosed with buprenorphine in the ED for withdrawal, buprenorphine prescriptions, and naloxone prescriptions Given nationwide changes in volume of patients seen in the ED during the coronavirus pandemic, the denominator used for these comparisons was per 1,000 ED patient visits Results: Prior to the X-waiver training, there were three X-waivered residents in the department 54 residents completed X-waiver training, and as of March 2020, 17 residents were X-waivered We saw marked increases in buprenorphine treatment and prescribing after the X-waiver intervention (see figure 1) These increases in treatment observed for OUD patients persisted while adjusting for ED volumes Conclusion: The X-waiver training effectively and markedly improved rates of buprenorphine and naloxone delivery to patients with OUD As the opiate epidemic continues to smolder, it will continue to be important to guide resident practice to comprehensive care for OUD This intervention provides a quantitative roadmap of MAT adoption for programs who provide X-waiver programming for residents [Formula presented]