Dekker Annette M, Schriger David L, Herring Andrew A, Samuels Elizabeth A
Department of Emergency Medicine, David Geffen School of Medicine, University of California, Los Angeles.
Associate Editor, JAMA.
JAMA. 2025 Apr 8;333(14):1232-1241. doi: 10.1001/jama.2024.27976.
Rates of opioid use disorder (OUD) and associated mortality in the US remain high. Treatment of OUD with buprenorphine reduces morbidity and mortality. There have been national efforts to expand buprenorphine initiation to the emergency department (ED), where many patients with low treatment access seek medical care. Adoption and trends of emergency clinician buprenorphine prescribing are unknown.
To describe emergency clinician buprenorphine initiation for OUD, subsequent prescriptions, and changes over time in California.
DESIGN, SETTING, AND PARTICIPANTS: Observational retrospective study of buprenorphine prescriptions in the California Controlled Substance Utilization Review and Evaluation System (CURES) database from January 1, 2017, to December 31, 2022. Any patient aged 18 to 79 years with a California zip code who filled a buprenorphine prescription in CURES and their California prescribers were eligible for inclusion.
Buprenorphine prescription by an emergency clinician.
Outcomes included (1) the number of patients prescribed buprenorphine; (2) the number of clinicians prescribing buprenorphine; (3) the number and characteristics of buprenorphine prescriptions; (4) the percentage of emergency clinician buprenorphine initiation prescriptions with subsequent linkage to a second prescription and continuous prescriptions, also reported as a continuation ratio; and (5) days and number of initiation prescriptions prior to continuous prescriptions.
In this retrospective observational study, 345 024 patients received 3.8 million buprenorphine prescriptions from 21 099 clinicians in California from 2017 to 2022. The mean age of patients at the time of first buprenorphine prescription was 37 years; 8187 (67%) were male. Emergency clinicians increased from 2% (n = 78) to 16% (n = 1789) of buprenorphine prescribers in 2017 and 2022, respectively (P < .001). Buprenorphine initiation prescriptions by emergency clinicians increased from 0.1% (n = 53) to 5% (n = 4493) of all initiation prescriptions in 2017 and 2022, respectively (P = .001). The continuation ratio for patients to receive a second prescription within 40 days of an ED initiation was 2.8 (10 823/3916). The continuation ratio for patients to start 180 days or more of continuous prescriptions within 40 days of ED buprenorphine initiation was 18.3 (10 823/593) and 9.1 within 1 year (5989/655 [2017-2021 data]).
These findings suggest increasing prescription of buprenorphine for OUD by California emergency clinicians from 2017 to 2022, with approximately 1 in 9 patients going on to receive continuous buprenorphine prescriptions within 1 year.
美国阿片类药物使用障碍（OUD）的发生率及相关死亡率仍然很高。使用丁丙诺啡治疗OUD可降低发病率和死亡率。国家一直在努力将丁丙诺啡起始治疗扩展至急诊科（ED），许多难以获得治疗的患者会在那里寻求医疗护理。急诊临床医生开具丁丙诺啡的采用情况和趋势尚不清楚。
描述加利福尼亚州急诊临床医生对OUD的丁丙诺啡起始治疗、后续处方以及随时间的变化情况。
设计、设置和参与者：对2017年1月1日至2022年12月31日加利福尼亚州管制物质使用审查和评估系统（CURES）数据库中的丁丙诺啡处方进行观察性回顾性研究。任何年龄在18至79岁、拥有加利福尼亚州邮政编码且在CURES中开具丁丙诺啡处方的患者及其加利福尼亚州处方医生均符合纳入标准。
急诊临床医生开具丁丙诺啡处方。
结局包括（1）开具丁丙诺啡处方的患者数量；（2）开具丁丙诺啡处方的临床医生数量；（3）丁丙诺啡处方的数量和特征；（4）急诊临床医生丁丙诺啡起始治疗处方后续与第二张处方相关联以及连续处方的比例，也报告为延续率；（5）连续处方之前起始处方的天数和数量。
在这项回顾性观察性研究中，2017年至2022年期间，加利福尼亚州的345,024名患者从21,099名临床医生处获得了380万张丁丙诺啡处方。首次开具丁丙诺啡处方时患者的平均年龄为37岁；8187名（67%）为男性。2017年和2022年，急诊临床医生分别占丁丙诺啡处方医生的2%（n = 78）和16%（n = 1789）（P <.001）。2017年和2022年，急诊临床医生开具的丁丙诺啡起始治疗处方分别占所有起始治疗处方的0.1%（n = 53）和5%（n = 4493）（P =.001）。在急诊科起始治疗后40天内接受第二张处方的患者延续率为2.8（10,823/3916）。在急诊科丁丙诺啡起始治疗后40天内开始180天或更长时间连续处方的患者延续率在18.3（10,823/593），在1年内为9.1（5989/655[2017 - 2021年数据]）。
这些发现表明，2017年至2022年期间加利福尼亚州急诊临床医生对OUD开具丁丙诺啡处方的情况有所增加，约九分之一的患者在1年内继续接受丁丙诺啡连续处方。
