Emergency department-initiated buprenorphine vs brief intervention for opioid use disorder: a systematic review and meta-analysis of clinical trials.
Ahmad Bavali-Gazik, Seyyedeh Negar Hosseini, Sajjad Salehian et al.
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In 30 seconds
This systematic review and meta-analysis pooled randomized and nonrandomized clinical trials comparing emergency department (ED)-initiated buprenorphine with brief intervention, referral, or usual care for opioid use disorder. Nine trials involving 1,172 participants, primarily in North America, were included. Buprenorphine initiation was associated with higher treatment adherence than brief intervention (61% vs 52%) and lower opioid use prevalence (17% vs 28%). Trials generally favored buprenorphine for short-term treatment engagement, although substantial heterogeneity and potential publication bias limit confidence in the pooled evidence.
Key findings
- Across nine trials (n = 1,172), adherence was 61% with ED-initiated buprenorphine versus 52% with brief intervention.
- Opioid use prevalence was 17% with buprenorphine initiation versus 28% with brief intervention.
- Multiple randomized trials favored buprenorphine for short-term treatment engagement; brief intervention showed minimal effects on reported outcomes.
- Heterogeneity was considerable (I² ≈ 99%), and potential publication bias was observed.
Why it matters
The ED can provide an opportunity to connect people with opioid use disorder to treatment. This synthesis suggests that initiating buprenorphine in that setting may improve short-term engagement and reduce opioid use compared with brief intervention, while underscoring that the evidence is variable and does not establish longer-term effects.
What to keep in mind
The evidence had considerable heterogeneity and potential publication bias; follow-up was short, and trials were primarily from North America.