
==== Front
J Am Coll Emerg Physicians Open
J Am Coll Emerg Physicians Open
10.1002/(ISSN)2688-1152
EMP2
Journal of the American College of Emergency Physicians Open
2688-1152
John Wiley and Sons Inc. Hoboken

10.1002/emp2.13272
EMP213272
Brief Report
General Medicine
Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in Nevada
AJUMOBI et al.
Ajumobi Olufemi MD, PhD https://orcid.org/0000-0002-2652-1205
1 2 6 femiajumobi@gmail.com

*
Friedman Sarah PhD 1
Westhoff John MD 3
Granner Michelle PhD 1
Lucero Julie PhD 4
Koch Brandon PhD 5
Wagner Karla D. PhD 1
1 School of Public Health University of Nevada Reno Nevada USA
2 North Carolina Department of Health and Human Services Raleigh North Carolina USA
3 Department of Internal Medicine University of Nevada Reno School of Medicine Reno Nevada USA
4 College of Health University of Utah Salt Lake City Utah USA
5 College of Public Health The Ohio State University Columbus Ohio USA
6 Present address: Oak Ridge Institute for Science and Education United States Department of Energy Oak Ridge Tennessee USA
* Correspondence
Olufemi Ajumobi, School of Public Health, University of Nevada, Reno, Reno, NV, USA.
Email: femiajumobi@gmail.com

06 9 2024
10 2024
5 5 10.1002/emp2.v5.5 e1327216 7 2024
03 2 2024
02 8 2024
© 2024 The Author(s). Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Abstract

Objectives

We described age, gender, race, and ethnicity associations with filling buprenorphine prescriptions post‐emergency department (post‐ED) visits.

Methods

We analyzed 1.5 years (July 1, 2020–December 31, 2021) of encounter‐level Medicaid ED and retail pharmacy claims data obtained from the Nevada Department of Health and Human Services. We studied ED patients with an opioid use disorder (OUD) diagnosis who did not fill a prescription for OUD medications within 6 months before the ED encounter. Using logistic regression, we modeled the associations between the patient's demographic characteristics and the outcome, filling a buprenorphine prescription at a community pharmacy within 14 or 30 days of the ED encounter.

Results

Among 2781 ED visits, representing 2094 patients, the median age was 39 years, 54% were male, 18.5% were Black, 11.7% were Hispanic, and 62.3% were White. Only 4% of the ED visits were followed by a filled buprenorphine prescription. Increasing age (14‐day window: adjusted odds ratio (aOR) = 0.965, 95% confidence interval [CI]: 0.948–0.983) and being a Black patient (14‐day window: aOR: 0.114, 95% CI 0.036–0.361) were both associated with lower odds of filled buprenorphine prescriptions. These results were similar within 30 days of an ED visit.

Conclusions

Initiation of buprenorphine following an ED visit remains low among Nevadan Medicaid patients and is less likely with increasing age and among Black patients, despite strong evidence supporting its use. Overburdened EDs, lack of attention from managers, and substance use stigma are among possible explanations. When ED clinicians do write buprenorphine prescriptions, peer recovery support could increase the fill rates.

buprenorphine
emergency department
Medicaid
opioid use disorder
source-schema-version-number2.0
cover-dateOctober 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:06.09.2024
Ajumobi O , Friedman S , Westhoff J , et al. Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in Nevada. JACEP Open. 2024;5 :e13272. 10.1002/emp2.13272

Supervising Editor: Christian A. Tomaszewski, MD, MBA
==== Body
pmc1 INTRODUCTION

1.1 Background

In 2021, over 75,000 Americans died from opioid overdoses. 1 Recommendations in Europe and North America emphasize increasing access to treatment with buprenorphine, a medication for opioid use disorder (OUD), which demonstrated reduced illicit opioid use, opioid overdose risk, and deaths. 2 , 3 , 4 Policies, such as the Drug Addiction Treatment Act of 2000, the Substance Abuse and Mental Health Services Final Rule, and the Comprehensive Addiction and Recovery Act, license clinicians to prescribe buprenorphine in office‐based settings. 5 , 6 , 7 However, based on the analysis of October 2013 to September 2016 claims data, only 21% of persons with OUD received buprenorphine treatment in an office‐based setting in an assessment in six states. 8 Also, buprenorphine is known to be underused nationally. 9

Buprenorphine can be prescribed in the emergency department (ED), although its use in this setting is nascent. 10 Initiation of buprenorphine in the ED may reduce barriers to buprenorphine treatment by facilitating access at the time of a visit, thus creating a “reachable moment.” 11 , 12 D'Onofrio and colleagues found that this approach increased buprenorphine use in a randomized clinical trial. 13 Buprenorphine treatment can be offered in macrodoses the same day to patients who are not abstinent from illicit opioid use, unlike naltrexone. 11 , 14 Macrodosing entails administering a high dose of buprenorphine treatment. 15 While buprenorphine is increasingly used in the ED to treat persons with OUD, 16 , 17 there is insufficient information on the proportion of ED visits for OUD that result in buprenorphine prescriptions being filled at a retail pharmacy after the visit, and the sociodemographic differences associated with this outcome.

1.2 Importance

Studies that have established age, gender, racial, and ethnic disparities in buprenorphine access are limited to office‐based outpatient settings. 18 In research conducted among non‐ED hospital outpatients, Black study participants had 77% lower odds of receiving buprenorphine at hospital visits compared to White participants, while males had 122% higher odds of receiving buprenorphine compared to females during hospital visits. 18 While middle‐aged persons (30–50 years) with OUD had 68% higher odds of receiving buprenorphine, older persons (>50 years) had 62% lower odds in the same study. 18 These disparities have not been reported in ED settings and serve as the basis for our study. It is important to document age, gender, racial, and ethnic disparities in buprenorphine treatment gaps as a first step toward developing targeted interventions in the ED.

The Bottom Line

There is insufficient information on the proportion of emergency department (ED) visits for opioid use disorder that result in buprenorphine prescriptions being filled at a retail pharmacy afterward. In an analysis of a Nevada Medicaid cohort, we found that 4% of patients with opioid use disorder initiated buprenorphine treatment following an ED visit, with this proportion being lower among older individuals and Black patients. When ED clinicians prescribe buprenorphine, peer recovery support is crucial for increasing buprenorphine fill rates, especially among Black patients who are at higher risk for overdose.

1.3 Goal of this investigation

We contribute new evidence on whether these disparities persist in the delivery of buprenorphine in the ED. In this study, we sought to: (1) quantify the frequency of buprenorphine use following ED visits among people with OUD diagnosis and, (2) establish the association between sociodemographic characteristics and buprenorphine prescriptions filled post‐ED visit.

2 METHODS

2.1 Study design and setting

This was a retrospective review of encounter‐level Nevada Medicaid ED and pharmacy claims data from July 1, 2020, to December 31, 2021. The study period was chosen to provide 18 months of statewide data. The data were obtained from the Office of Analytics, Nevada Department of Health and Human Services. The institutional review board of the University of Nevada, Reno #1861327‐3 approved the study.

We studied ED visits for patients who had an OUD diagnosis but were naïve to medication for OUD (i.e., no evidence in the claims data of receiving any medication for OUD within 6 months of ED visit). ED visits were determined to be for OUD when the ED visit claim record had any of the ICD‐10 diagnosis codes: F11–F11.99. Buprenorphine naïve was identified by the absence of buprenorphine prescriptions during the 6 months before the ED visit. The 6‐month look‐back period was designed to balance the sensitivity of capturing buprenorphine prescriptions truly filled for OUD naïve patients and the specificity of not capturing patients with prior buprenorphine prescriptions filled for OUD use. Given that the National Quality Forum quality measure #468 uses a threshold of 7 days to indicate a break in buprenorphine treatment continuity, we believe the 6‐month threshold achieves this balance. 19 , 20

3 MEASURES

3.1 Outcomes

The outcomes of interest were whether the patient filled buprenorphine at a retail pharmacy (1 = yes) or not (0 = no) within a threshold number of days after an ED visit with an associated OUD diagnosis. Specifically, prescriptions filled within 14 days (representing the time expected to elapse before a prescription expires) and 30 days (based on a prior study which indicated patients continued buprenorphine use at 30‐day post‐ED visit 13 ) were counted. To determine whether the buprenorphine prescription was filled within each time frame, we merged ED visit dates with pharmacy claim fill dates. Buprenorphine prescriptions were identified in pharmacy claims using national drug codes compiled by the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control. 21

3.2 Predictors

We created age groups (15–24, 25–34, 35–44, 45–54, 55–64, 65+) and gender (1 = female, 0 = male) variables from ED claims. We defined four “race and ethnicity” categories: Asian and others, Black, Hispanic, and White. The patients were coded as Hispanic if the race and ethnicity variable in the Medicaid data identified them as Hispanic or a combination of Hispanic and any other race. Those identified in the data as non‐Hispanic Black and non‐Hispanic White were coded as Black and White, respectively. Due to the small numbers of “Asians and other categories of race and ethnicity” in the data, we created a combined category (see Supporting Information for detailed mapping of race and ethnicity categories).

3.3 Analysis

Associations between independent variables (age, gender, race, and ethnicity) and the dependent variable (filled buprenorphine prescription) were estimated using a logistic regression. We presented odds ratios and the corresponding 95% confidence intervals. Data were analyzed using SAS version 9.4.

3.4 Main results

We studied 2781 person‐visits representing 2094 patients. Among them, the median age was 39 years (interquartile range [IQR]: 32–52; data not shown in the table), 54% were male, 62.3% were White, 18.5% were Black, and 11.7% were Hispanic (Table 1).

TABLE 1 Demographic characteristics of persons with opioid use disorder (OUD) with emergency department (ED) visits, by 14‐day buprenorphine prescription status (N = 2781).

Characteristics	Overall (N = 2781) Frequency (%)	Filled buprenorphine a (N = 105)

Frequency (%)

	Did not fill buprenorphine (N = 2676)

Frequency (%)

	
Age		
15–24	133 (4.8)	5 (4.8)	128 (4.8)	
25–34	865 (31.1)	40 (38.0)	825 (30.8)	
35–44	786 (28.3)	46 (43.8)	740 (27.7)	
45–54	457 (16.4)	7 (6.7)	450 (16.8)	
55–64	391 (14.1)	6 (5.7)	385 (14.4)	
65+	149 (5.4)	1 (1.0)	148 (5.5)	
Gender		
Male	1501 (54.0)	57 (54.3)	1444 (54.0)	
Female	1280 (46.0)	48 (45.7)	1232 (46.0)	
Race and ethnicity		
Asian and others	209 (7.52)	8 (7.6)	201 (7.5)	
Black	514 (18.5)	3 (2.9)	511 (19.1)	
Hispanic	325 (11.7)	10 (9.5)	315 (11.8)	
White	1733 (62.3)	84 (80)	1649 (61.6)	
a Filled a buprenorphine prescription within 14 days of the ED visit.

John Wiley & Sons, Ltd.

3.5 Filled buprenorphine prescription at the pharmacy

There were 105 (3.8%) and 132 (4.8%) buprenorphine prescription‐filled person‐visits for the 14‐ and 30‐day windows, respectively. The median number of days between the ED visit and the buprenorphine fill was 6 (IQR: 4–9) and 7 (IQR: 5–12) for the 14‐ and 30‐day windows, respectively.

3.6 Factors associated with filling buprenorphine after an ED visit

For every year increase in age, there was an estimated 3.5% decrease in the odds of filling a buprenorphine prescription within 14 days (aOR: 0.965, 95% confidence interval [CI]: 0.948–0.983) (see Table 2). Compared to White, being a Black patient was also associated with 88.6% reduced odds of filling a buprenorphine prescription within 14 days (aOR: 0.114, 95% CI: 0.036–0.361). Gender was not associated with the outcome. The results were similar for the outcome using the 30‐day window (Table 2).

TABLE 2 Predictors of filling buprenorphine at the pharmacy among all persons with opioid use disorder (OUD) with emergency department (ED) visits (N = 2781).

	14‐day window	30‐day window	
Characteristics	aOR (95% CI)	p‐value	aOR (95% CI)	p‐value	
Age a	0.965 (0.948–0.983)	0.0002	0.963 (0.947–0.979)	<0.0001	
Female	1.051 (0.708–1.561)	0.8046	1.072 (0.751–1.529)	0.7031	
Race and ethnicity					
Asian and others	0.658 (0.311–1.390)	0.2160	0.709 (0.371–1.353)	0.0628	
Black	0.114 (0.036–0.361)	0.0026	0.088 (0.028–0.280)	0.0006	
Hispanic	0.514 (0.262–1.010)	0.6171	0.479 (0.258–0.888)	0.6137	
a Age as a continuous variable.

John Wiley & Sons, Ltd.

4 LIMITATIONS

Our study has some potential for misclassification of the outcome construct (prescriptions written in the ED). We may have undercounted buprenorphine prescriptions written if not all prescriptions written in the ED were filled or if patients filled and paid for ED prescriptions using self‐pay or other non‐Medicaid insurance. 18 Another potential source of misclassification also relates to our outcome construct. 22 We may have overcounted buprenorphine prescriptions if prescriptions assumed to have been written in the ED (based on being filled within 14 or 30 days of the patient's ED visit) were actually written in any other setting. Despite these sources of potential misclassification, prescriptions filled at a pharmacy have been identified as a reliable measure of prescribing behavior. 23 , 24

Also, our findings could have been influenced by the COVID‐19 pandemic, since hospitals were focused on the pandemic response and may not have been equipped to attend to substance use disorder treatment needs among persons with OUD. 25 Another important historical event that could have influenced our findings is that buprenorphine practice guidelines were updated to replace the X‐waiver with a “notice of intent” in April 2021. Theoretically, this should have increased the availability of buprenorphine prescribing in ED settings. However, the effect of the COVID‐19 pandemic might have persisted, reducing ED‐initiated buprenorphine prescriptions and ultimately limiting the filling of the prescriptions at the pharmacy. 24

A final limitation pertains to the scope of the present analysis. While we did not have access to patient characteristics such as income (beyond Medicaid eligibility criteria), occupation, or education, the present research could be extended to these and other demographic characteristics to give a more complete picture of ED buprenorphine prescribing. Another fruitful direction for future research would be to explore the hospital, ED, and clinician characteristics associated with successful buprenorphine initiation. The generalizability of the findings may not extend beyond Medicaid in Mountain West states with similar age, and race and ethnicity distributions.

5 DISCUSSION

Our study analyzed Nevada Medicaid data from 2020 to 2021 and examined the prevalence of and demographic factors associated with filling a buprenorphine prescription within 14 and 30 days of an ED visit among people with an OUD diagnosis. Only about 4% of ED visits by persons with an OUD diagnosis were followed by a filled buprenorphine prescription, which means that the vast majority did not fill a prescription. Many of the ED visits for OUD‐diagnosed patients may represent missed opportunities to initiate patients onto buprenorphine treatment through the ED. Implementing patient‐oriented interventions such as positioning peer recovery support specialists (PRSSs) at the EDs can potentially increase buprenorphine prescription fill rates at the retail pharmacies. A PRSS is someone with lived experience of OUD but is currently in recovery, and it can provide information about available community resources for outpatient treatment continuity. 26 , 27

Younger age and White race were associated with increased odds of filling a buprenorphine prescription. This novel finding is at variance with our hypothesis that older age individuals would be more likely to fill a buprenorphine prescription after presenting in the ED, 19 which was based on the other studies that observed a correlation between older age and buprenorphine use in the outpatient setting, 19 and studies which showed adolescents and young adults have fewer opportunities for treatment initiation. 28 One possible explanation for our finding is that older individuals with longer drug use careers may actually prefer methadone over buprenorphine because of its higher retention rate in treatment 29 or the perceived risk of buprenorphine precipitated acute withdrawal associated with concurrent fentanyl use. 30 However, current evidence indicates buprenorphine precipitated acute withdrawal is rare with fentanyl use (0.76%). 31 Reasons for reduced odds of filling a buprenorphine prescription following an ED visit among older persons with OUD are worth examining further.

We found that Black patients with OUD had lower odds of filling buprenorphine prescriptions after an ED visit compared to their White counterparts, which is consistent with previous studies in outpatient settings and pharmacy claims. 18 , 24 Historically, racial and ethnic minority groups, including those who are enrolled in Medicaid, 32 experience disparate access to medication for OUD. 18 , 33 This is supported both in a clinical trial 34 and in real‐world settings. 35 In the context of the current opioid overdose crisis, ED‐initiated buprenorphine treatment provides a unique opportunity to increase equitable access to OUD treatment and therefore prevent subsequent overdose deaths in persons with OUD irrespective of race and ethnicity.

Previous studies suggest an association between gender and filling buprenorphine prescriptions at the pharmacy. 18 , 36 The absence of an association with gender in our data differs from earlier studies and the reason for this is not clear.

The average 6‐day delay in filling buprenorphine prescriptions among these Medicaid enrollees study cohort is noteworthy. This implies the patients could have resumed illicit opioid use for nearly a week before commencing daily buprenorphine treatment. The potential reason for this patient's hesitancy in filling buprenorphine prescriptions is worth examining further in qualitative studies.

Our study found a low frequency of buprenorphine prescriptions filled by people with OUD in the 14‐ and 30‐day following a visit to Nevada's EDs. We also found associations between the filling of buprenorphine prescriptions and demographic factors that could signal the potential for age and racial and ethnic‐based disparities in treatment access. Overburdened EDs, lack of leadership support, and substance use stigma are among possible explanations. 25 , 37 , 38 These have programmatic implications. There is a need to focus attention on older adults and Black patients as the State of Nevada gradually routinizes the implementation of ED‐initiated take‐home buprenorphine for persons with OUD. When ED clinicians do write buprenorphine prescriptions, patient‐oriented interventions such as peer recovery support could increase the fill rates.

AUTHOR CONTRIBUTIONS

Olufemi Ajumobi conceived the study with contributions from Sarah Friedman and Karla D. Wagner and designed the data collection analysis plan with supervision from Sarah Friedman and Karla D. Wagner and contributions from John Westhoff, Michelle Granner, Julie Lucero, and Brandon Koch. Olufemi Ajumobi drafted the manuscript, and all authors contributed substantially to its revision. Olufemi Ajumobi takes responsibility for the paper as a whole.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

Supporting information

Supporting Information

ACKNOWLEDGMENTS

The authors are grateful to the Nevada Medicaid Data Analytics Team at the Office of Analytics, Nevada Department of Health and Human Services for providing the data used for this study.

Olufemi Ajumobi, MD, MPH, PhD, is an ORISE Postdoctoral Fellow at the U.S. FDA. His mixed‐method doctoral research explored the unmet need for buprenorphine treatment for opioid use disorder in Nevada emergency departments and associated sociodemographic differences, factors related to the intention to prescribe buprenorphine, and how the perspectives of emergency physicians influence decision‐making related to prescribing buprenorphine.
==== Refs
REFERENCES

1 Centers for Disease Control and Prevention . Drug overdose deaths in the U.S. top 100,000 annually. Accessed November 14, 2022. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm
2 D'Onofrio G , Chawarski MC , O'Connor PG , et al. Emergency department‐initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention. J Gen Intern Med. 2017;32 (6 ):660‐666. doi:10.1007/s11606-017-3993-2 28194688
3 Johns SE , Bowman M , Moeller FG . Utilizing buprenorphine in the emergency department after overdose. Trends Pharmacol Sci. 2018;39 (12 ):998‐1000. doi:10.1016/j.tips.2018.10.002 30454771
4 Dematteis M , Auriacombe M , D'Agnone O , et al. Recommendations for buprenorphine and methadone therapy in opioid use disorder: a European consensus. Expert Opin Pharmacother. 2017;18 (18 ):1987‐1999. doi:10.1080/14656566.2017.1409722 29183228
5 U.S. Congress . Drug addiction treatment act of 2000. Accessed November 20, 2022. https://www.congress.gov/bill/106th‐congress/house‐bill/2634
6 Health and Human Services Department . Medication assisted treatment for opioid use disorders. 2016.
7 U.S. Congress . Comprehensive addiction and recovery act of 2016. 2016. Accessed November 20, 2022. https://www.congress.gov/bill/114th‐congress/senate‐bill/524/text
8 Lapham G , Boudreau DM , Johnson EA , et al. Prevalence and treatment of opioid use disorders among primary care patients in six health systems. Drug Alcohol Depend. 2020;207 :107732. doi:10.1016/j.drugalcdep.2019.107732 31835068
9 Tanz LJ , Jones CM , Davis NL , et al. Trends and characteristics of buprenorphine‐involved overdose deaths prior to and during the COVID‐19 pandemic. JAMA Netw Open. 2023;6 (1 ):e2251856. doi:10.1001/jamanetworkopen.2022.51856 36662523
10 Chua K‐P , Dahlem CHY , Nguyen TD , et al. Naloxone and buprenorphine prescribing following us emergency department visits for suspected opioid overdose: august 2019 to April 2021. Ann Emerg Med. 2022;79 (3 ):225‐236. doi:10.1016/j.annemergmed.2021.10.005 34802772
11 Jakubowski A , Fox A . Defining low‐threshold buprenorphine treatment. J Addict Med. 2020;14 (2 ):95‐98. doi:10.1097/ADM.0000000000000555 31567596
12 Shanahan CW , Beers D , Alford DP , Brigandi E , Samet JH . A transitional opioid program to engage hospitalized drug users. J Gen Intern Med. 2010;25 (8 ):803‐808. doi:10.1007/s11606-010-1311-3 20237960
13 D'Onofrio G , O'Connor PG , Pantalon MV , et al. Emergency department‐initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313 (16 ):1636‐1644. doi:10.1001/jama.2015.3474 25919527
14 Schuckit MA . Treatment of opioid‐use disorders. N Engl J Med. 2016;375 (16 ):1596‐1597. doi:10.1056/NEJMc1610830
15 Herring AA , Vosooghi AA , Luftig J , et al. High‐Dose buprenorphine induction in the emergency department for treatment of opioid use disorder. JAMA Netw Open. 2021;4 (7 ):e2117128. doi:10.1001/jamanetworkopen.2021.17128 34264326
16 Bogan C , Jennings L , Haynes L , et al. Implementation of emergency department‐initiated buprenorphine for opioid use disorder in a rural southern state. J Subst Abuse Treat. 2020;112S :73‐78. doi:10.1016/j.jsat.2020.02.007 32220414
17 Snyder H , Kalmin MM , Moulin A , et al. Rapid adoption of low‐threshold buprenorphine treatment at California emergency departments participating in the CA bridge program. Ann Emerg Med. 2021;83 :522‐538. doi:10.1016/j.annemergmed.2021.05.024
18 Lagisetty PA , Ross R , Bohnert A , Clay M , Maust DT . Buprenorphine treatment divide by race/ethnicity and payment. JAMA Psychiat. 2019;76 (9 ):979‐981. doi:10.1001/jamapsychiatry.2019.0876
19 Olfson M , Zhang VS , Schoenbaum M , King M . Trends in buprenorphine treatment in the United States, 2009–2018. JAMA. 2020;323 (3 ):276‐277. doi:10.1001/jama.2019.18913 31961408
20 National Quality Forum . Behavioral health 2016–2017: Final report. August 2017. Accessed December 19, 2022. https://www.qualityforum.org/Publications/2017/08/Behavioral_Health_2016‐2017_Final_Report.aspx
21 National Center for Injury Prevention and Control . CDC compilation of benzodiazepines, muscle relaxants, stimulants, zolpidem, and opioid analgesics with oral morphine milligram equivalent conversion factors. Centers for Disease Control and Prevention. 2017.
22 Harmon RJ , Morgan GA , Gliner JA . Evaluating the validity of a research study. J Am Acad Child Adolesc Psychiatry. 1999;38 (4 ):480‐485. doi:10.1097/00004583-199904000-00023 10199122
23 Cance JD , Doyle E . Changes in outpatient buprenorphine dispensing during the COVID‐19 pandemic. JAMA. 2020;324 (23 ):2442‐2444. doi:10.1001/jama.2020.22154 33320215
24 Nguyen T , Ziedan E , Simon K , et al. Racial and ethnic disparities in buprenorphine and extended‐release naltrexone filled prescriptions during the COVID‐19 pandemic. JAMA Netw Open. 2022;5 (6 ):e2214765. doi:10.1001/jamanetworkopen.2022.14765 35648400
25 Soares WE , Melnick ER , Nath B , et al. Emergency department visits for nonfatal opioid overdose during the COVID‐19 pandemic across six US health care systems. Ann Emerg Med. 2022;79 :158‐167. doi:10.1016/j.annemergmed.2021.03.013 34119326
26 McGuire AB , Powell KG , Treitler PC , et al. Emergency department‐based peer support for opioid use disorder: emergent functions and forms. J Subst Abuse Treat. 2020;108 :82‐87. doi:10.1016/j.jsat.2019.06.013 31280928
27 Wagner KD , Mittal ML , Harding RW , et al. “It's gonna be a lifeline”: findings from focus group research to investigate what people who use opioids want from peer‐based postoverdose interventions in the emergency department. Ann Emerg Med. 2020;76 (6 ):717‐727. doi:10.1016/j.annemergmed.2020.06.003 32747080
28 Hall OT , Trimble C , Garcia S , Entrup P , Deaner M , Teater J . Unintentional drug overdose mortality in years of life lost among adolescents and young people in the US from 2015 to 2019. JAMA Pediatrics. 2022;176 (4 ):415‐417. doi:10.1001/jamapediatrics.2021.6032 35099529
29 Zhang P , Tossone K , Ashmead R , et al. Examining differences in retention on medication for opioid use disorder: an analysis of Ohio Medicaid data. J Subst Abuse Treat. 2022;136 :108686. doi:10.1016/j.jsat.2021.108686 34953637
30 Spreen LA , Dittmar EN , Quirk KC , Smith MA . Buprenorphine initiation strategies for opioid use disorder and pain management: a systematic review. Pharmacotherapy. 2022;42 (5 ):411‐427. doi:10.1002/phar.2676 35302671
31 D'Onofrio G , Hawk KF , Perrone J , et al. Incidence of precipitated withdrawal during a multisite emergency department‐initiated buprenorphine clinical trial in the era of fentanyl. JAMA Netw Open. 2023;6 (3 ):e236108. doi:10.1001/jamanetworkopen.2023.6108 36995717
32 Yue D , Rasmussen PW , Ponce NA . Racial/ethnic differential effects of medicaid expansion on health care access. Health Serv Res. 2018;53 (5 ):3640‐3656. doi:10.1111/1475-6773.12834 29468669
33 Stein BD , Dick AW , Sorbero M , et al. A population‐based examination of trends and disparities in medication treatment for opioid use disorders among Medicaid enrollees. Subst Abus. 2018;39 (4 ):419‐425. doi:10.1080/08897077.2018.1449166 29932847
34 Holland WC , Li F , Nath B , et al. Racial and ethnic disparities in emergency department‐initiated buprenorphine across 5 healthcare systems. Acad Emerg Med. 2023;30 :709‐720. doi:10.1111/acem.14668 36660800
35 Barnett ML , Meara E , Lewinson T , et al. Racial inequality in receipt of medications for opioid use disorder. N Engl J Med. 2023;388 (19 ):1779‐1789. doi:10.1056/NEJMsa2212412 37163624
36 Landis RK , Levin JS , Saloner B , et al. Sociodemographic differences in quality of treatment to Medicaid enrollees receiving buprenorphine. Substance Abuse. 2022;43 (1 ):1057‐1071. doi:10.1080/08897077.2022.2060424 35442178
37 Hawk KF , D'Onofrio G , Chawarski MC , et al. Barriers and facilitators to clinician readiness to provide emergency department‐initiated buprenorphine. JAMA Netw Open. 2020;3 (5 ):e204561. doi:10.1001/jamanetworkopen.2020.4561 32391893
38 Pourmand A , Beisenova K , Shukur N , Tebo C , Mortimer N , Mazer‐Amirshahi M . A practical review of buprenorphine utilization for the emergency physician in the era of decreased prescribing restrictions. Am J Emerg Med. 2021;48 :316‐322. doi:10.1016/j.ajem.2021.06.065 34274576
