Conversations can save lives: TALKing About Buprenorphine & methadone for Opioid Use Treatment Initiation (TALK ABOUT)

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PROJECT SUMMARY In the past two decades, over half a million people in the United States have died of an opioid overdose, and currently nearly 3 million Americans struggle with opioid use disorder. Medications for opioid use disorder (MOUD), such as buprenorphine and methadone, are effective in decreasing a person’s risk of death and disease from opioid use. However, only a small minority of people who would benefit from these medications have access to them. Although this treatment gap is multifactorial, treatment initiation locales outside of the current addiction paradigm are necessary to address the increasing morbidity and mortality of the opioid epidemic. Existing evidence demonstrates that buprenorphine dispensed from the Emergency Department (ED) increases the likelihood a person will be in treatment at 30 days, and treatment adherence is strongly linked to morbidity and mortality. Based on the known effectiveness of MOUD, the American College of Emergency Physicians recently released a recommendation that all appropriate patients be offered these medications when seen for ED care. However, most patients seen in a US ED are not offered these medications. Research demonstrates that interpersonal barriers such as stigma and mistrust may preclude effective conversations regarding these treatment options. Shared Decision-Making (SDM) – where clinicians specifically invite patients into clinical decision-making when options are available – has been used to increase the patient-centeredness of care in numerous settings but has generally not been employed in the ED for patients with opioid use disorder. Through stakeholder engagement, our team has created an intervention, Talk About It, which uses an SDM framework to facilitate conversations about MOUD in the ED. Conversations can foster empathy, build trust, diminish stigma, and help people start their path to recovery. Additionally, U.S. policy regarding the prescription of MOUD recently changed, vastly increasing the number of potential prescribers. These providers, however, will need tools for these challenging conversations. Our long-term goal is to increase and improve discussions about MOUD in the ED, increasing initiation and adherence, and decreasing morbidity and mortality. In Aim 1 of this R34, we will refine our intervention via qualitative and quantitative feedback from clinicians and patients. In Aim 2, we will pilot procedures for a fully powered multicenter trial. Aim 2 includes: A) a pilot of the training intervention for clinicians, including the collection of baseline and 12-month data; B) prospective enrollment of patients and collection of patient- centered outcomes; C) assessment of clinical outcomes; and D) a feasibility analysis of study procedures. This will be the first study to use the patient-centered framework of Shared Decision-Making to address this substantial treatment gap – increasing the ability of ED clinicians to meaningfully address the devastating morbidity and mortality of the opioid epidemic.