JAMA network open · 2026
Patient Perspectives on Offers of Buprenorphine in the Emergency Department.
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Jennings Lindsey K, Barth Kelly, Lane Suzanne, Rafferty Alyssa, Papa Carrie, Haynes Louise, Sonne Susan, McCowin Heather, Moschella Phillip, Litwin Alain H, Manteuffel Jacob J, Brady Kathleen, Moreland Angela
Аннотация
IMPORTANCE: Buprenorphine reduces mortality in opioid use disorder (OUD), and emergency department-initiated buprenorphine (EDIB) doubles 30-day treatment retention, yet many patients decline EDIB when offered. Patient-driven factors limiting uptake are not well characterized.
OBJECTIVE: To identify factors associated with patients accepting or declining EDIB.
DESIGN, SETTING, AND PARTICIPANTS: Convergent parallel mixed-methods qualitative study conducted from May 1 to December 31, 2023, with data analyses performed from March 2025 to April 2026, at 4 emergency departments within the National Drug Abuse Treatment Clinical Trials Network (CTN) in South Carolina, Michigan, and Ohio. Adult patients (aged ≥18 years) with OUD who were offered buprenorphine by clinical staff were eligible; prisoners and patients concurrently enrolled in other CTN trials of OUD treatment or overdose prevention were excluded.
MAIN OUTCOMES AND MEASURES: The main outcomes were acceptance or declination of EDIB; validated measures of treatment readiness (Stages of Change Readiness and Treatment Engagement Scale [SOCRATES]), cultural mistrust, perceived discrimination, and social needs; and qualitative interview themes regarding reasons for accepting or declining buprenorphine.
RESULTS: Eighty-two participants completed the study (median [IQR] age, 38 [31-53.5] years; 52 male [64%]). Overall, 19 participants (23%) declined buprenorphine. Among 54 participants who described reasons for accepting EDIB, motivators for accepting EDIB included assistance with opioid withdrawal (37 [69%]), desire to be substance free (21 [39%]), wanting to return to a "normal life" (15 [28%]), fear of overdose or death (13 [24%]), and caring for children (7 [13%]). Among 22 participants who described reasons for declining EDIB, barriers included concern about precipitated withdrawal or adverse effects (11 [50%]), not wanting to be physically dependent on buprenorphine (7 [32%]), and housing and logistical barriers (5 [23%]). SOCRATES treatment readiness (1-5 scale) was similar in patients who accepted (mean [SD] score, 4.11 [0.55]) and declined (mean [SD] score, 4.05 [0.50]) EDIB.
CONCLUSIONS AND RELEVANCE: In this mixed-methods qualitative study of adult ED patients with OUD who were offered buprenorphine, declination was driven less by low treatment readiness than by specific, addressable concerns: precipitated withdrawal, physical dependence, and housing and logistical barriers. Targeted interventions addressing these concerns may increase uptake of this life-saving treatment.
OBJECTIVE: To identify factors associated with patients accepting or declining EDIB.
DESIGN, SETTING, AND PARTICIPANTS: Convergent parallel mixed-methods qualitative study conducted from May 1 to December 31, 2023, with data analyses performed from March 2025 to April 2026, at 4 emergency departments within the National Drug Abuse Treatment Clinical Trials Network (CTN) in South Carolina, Michigan, and Ohio. Adult patients (aged ≥18 years) with OUD who were offered buprenorphine by clinical staff were eligible; prisoners and patients concurrently enrolled in other CTN trials of OUD treatment or overdose prevention were excluded.
MAIN OUTCOMES AND MEASURES: The main outcomes were acceptance or declination of EDIB; validated measures of treatment readiness (Stages of Change Readiness and Treatment Engagement Scale [SOCRATES]), cultural mistrust, perceived discrimination, and social needs; and qualitative interview themes regarding reasons for accepting or declining buprenorphine.
RESULTS: Eighty-two participants completed the study (median [IQR] age, 38 [31-53.5] years; 52 male [64%]). Overall, 19 participants (23%) declined buprenorphine. Among 54 participants who described reasons for accepting EDIB, motivators for accepting EDIB included assistance with opioid withdrawal (37 [69%]), desire to be substance free (21 [39%]), wanting to return to a "normal life" (15 [28%]), fear of overdose or death (13 [24%]), and caring for children (7 [13%]). Among 22 participants who described reasons for declining EDIB, barriers included concern about precipitated withdrawal or adverse effects (11 [50%]), not wanting to be physically dependent on buprenorphine (7 [32%]), and housing and logistical barriers (5 [23%]). SOCRATES treatment readiness (1-5 scale) was similar in patients who accepted (mean [SD] score, 4.11 [0.55]) and declined (mean [SD] score, 4.05 [0.50]) EDIB.
CONCLUSIONS AND RELEVANCE: In this mixed-methods qualitative study of adult ED patients with OUD who were offered buprenorphine, declination was driven less by low treatment readiness than by specific, addressable concerns: precipitated withdrawal, physical dependence, and housing and logistical barriers. Targeted interventions addressing these concerns may increase uptake of this life-saving treatment.