Bozinoff Nikki, Grennell Erin, Soobiah Charlene, Farhan Zahraa, Rodak Terri, Bucago Christine, Kingston Katie, Klaiman Michelle, Poynter Brittany, Shelton Dominick, Schoenfeld Elizabeth, Kalocsai Csilla
Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, Ontario, Canada.
Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, Canada.
Lancet Reg Health Am. 2024 Sep 28;38:100899. doi: 10.1016/j.lana.2024.100899. eCollection 2024 Oct.
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.
在急诊科启动丁丙诺啡被视为缓解阿片类药物过量危机的一项循证策略，但其实施情况有限。本范围综述总结了急诊科启动丁丙诺啡的障碍和促进因素，并运用实施研究综合框架和批判性视角对文献进行分析。结果表明，美国和加拿大为实施急诊科启动丁丙诺啡付出了巨大努力。促进因素包括多学科成瘾治疗团队以及共同选址、低门槛、基于减少伤害理念的服务以支持转诊。障碍包括未能消除结构性污名、服务对象情况复杂以及药物供应毒性日益增加。文献还未纳入服务使用者、卫生管理人员和学习者的观点。美国和加拿大都需要加强实施工作的协调，并转向公平和包容的阿片类激动剂治疗启动途径。
