Emergency Department-facilitated Buprenorphine Initiation for Opioid Use Disorder in Adolescents and Young Adults: A Retrospective Case Series

Introduction: Adolescent opioid-involved overdose deaths have risen sharply since 2019, largely driven by illicit fentanyl, and drug overdose is now a leading cause of death among US adolescents and young adults (AYA). Medications for opioid use disorder (MOUD), particularly buprenorphine and methadone, are known to reduce mortality in adults. Emergency Departments (EDs) have emerged as a pillar for MOUD initiation in this population. However, buprenorphine is underutilized in the AYA population. There is limited data available on buprenorphine initiation among AYA patients in the emergency department (ED). Objectives: In this retrospective case series 18 AYA patients aged 13–20 years old with opioid use disorder were initiated on buprenorphine/naloxone in the pediatric ED or instructed on home initiation. Data including patient age, buprenorphine dosing, continued prescription refills at 3 and 6 months, COWS (Clinical Opioid Withdrawal Scale) scores, other medication to treat opioid withdrawal in the ED, and adverse events, was abstracted from clinical records, the statewide prescription monitoring database, and public records. Results: Eight patients received prescriptions for buprenorphine from the ED to initiate at home. Ten patients underwent ED-initiated buprenorphine, of these, 1 was admitted. Most patients received 4–8 mg of buprenorphine daily. A significant minority of patients required adjunctive medication for symptom management. Follow-up was robust with 72% refilling a second prescription and 56% refilling prescriptions at 6 months. Conclusions: Pediatric ED-facilitated buprenorphine/naloxone initiation was shown to be safe and demonstrated favorable linkage to ongoing treatment.