Buprenorphine linked to fewer opioid-related ED visits

Key takeaways:

• Buprenorphine, especially the extended-release formulation, reduced future ED visits in patients with opioid use disorder.
• Previous overdose history may contribute to higher risk for ED visits.

Patients with opioid use disorder treated with buprenorphine reported less frequent ED visits than untreated patients, according to a retrospective study published in Drug and Alcohol Dependence Reports.

The results showed that extended-release buprenorphine, which ensures consistently sustained medication levels, was particularly effective.

Opioid overdose visits are packing EDs, with more than 1,000 related visits reported daily in the U.S., Sabrina Gaiazov, MPH, associate director of real-world evidence at Indivior, a pharmaceutical firm, and colleagues wrote.

Although buprenorphine offers potential to mitigate these ED visits, research on the treatment is limited, they noted.

Sabrina Gaiazov

“There’s still limited research on what drives ED utilization or how outcomes vary across buprenorphine formulations,” Gaiazov told Healio. “Understanding these factors is essential for improving care, guiding interventions and shaping effective policy.”

Using 2017 to 2022 patient claims data from IQVIA’s database, Gaiazov and colleagues evaluated associations between patient characteristics and all-cause or opioid overdose-related ED visits across buprenorphine treatment groups after 6 months.

Researchers divided patients into three treatment groups:

• extended-release buprenorphine (n = 543; mean age; 34.3 years; 60.4% men);
• transmucosal buprenorphine (n = 52,569; mean age, 40 years; 51.9% men); and
• no medications for opioid use disorder (n = 57,125; mean age, 50.4 years, 54.6% women).

Results showed that subsequent all-cause ED visits were less common among patients who received extended-release buprenorphine (27.8%; OR = 0.43; 95% CI, 0.36-0.53) or transmucosal buprenorphine (35.7%; OR = 0.78; 95% CI, 0.76-0.81) compared with the no-treatment group (37.4%).

Over 6 months, 1.2% of patients in the transmucosal buprenorphine group and 1% of those in the no-treatment group had at least one opioid overdose ED visit, along with no patients in the extended-release group. A logistic regression model adjusted for confounding factors showed reduced odds for an opioid ED visit in the transmucosal group (OR = 0.77; 95% CI, 0.68-0.88).

Notably, men (OR = 1.64; 95% CI, 1.46-1.85), those previously prescribed naloxone (OR = 1.55; 95% CI, 1.26-1.89) and individuals who previously had an opioid overdose-related ED visit (OR = 5.61; 95% CI, 4.54-6.94) had higher odds for a future ED visit.

“These predictors, particularly prior opioid overdose ED visits, underscore how past acute events remain a strong signal for future risk,” Gaiazov said. “From literature, we know that most individuals experience one or more nonfatal overdoses before a fatal one, making it critical to recognize these events as urgent opportunities for intervention.”

Researchers next compared health care resource utilization and costs across treatment groups, finding that the extended-release group, compared with the transmucosal and no-treatment groups, had fewer inpatient (3% vs. 5% vs. 10%), outpatient (60% vs. 67% vs. 72%) and ED (28% vs. 36% vs. 37%) visits.

These improvements extended to costs, as the extended-release group had significantly lower mean inpatient costs than the other groups ($282 vs. $1,404 vs. $3,336) and outpatient costs compared with the no-treatment group ($4,184 vs. $7,639).

However, overall costs for the extended-release group appeared similar to those of the no-treatment group ($12,995 vs. $13,623) and were higher than those of the transmucosal treatment group ($8,733), likely stemming from higher outpatient pharmacy costs, the researchers wrote.

Overall, both extended-release and transmucosal buprenorphine reduced odds for ED visits compared with no medication, with extended-release treatment resulting in fewer hospitalizations and overdose events, according to the researchers. These findings indicate buprenorphine can help “alleviate the burden” on EDs for patients with opioid use disorder, Gaiazov noted.

“Choosing the appropriate medication and formulation for patients can reduce acute care needs, improve treatment stability and help close gaps in care,” she said.

Recognizing a patient’s history is also important for determining their risk for subsequent ED visits, according to the researchers.

“Knowing if a patient has a prior overdose ED visit or certain comorbidities can prompt clinicians to proactively discuss long-acting treatment options, strengthen follow-up and connect them with wrap-around support,” Gaiazov added.

Future research should explore demographic factors, which were unavailable in the observed databases, and long-term outcomes, Gaiazov and colleagues noted.

“We should next look at longer-term outcomes for extended-release buprenorphine in ED settings with larger treatment cohorts,” Gaiazov said. “By using predictive risk factors, we can identify high-risk OUD patients and evaluate whether offering extended-release buprenorphine to these patients consistently reduces ED, hospital and office visits.”

For more information:

Sabrina Gaiazov, MPH, can be reached on LinkedIn.