Wisconsin Opioid Prevention and Treatment Research Network (WI OPTRN)

University Of Wisconsin-Madison, Madison WI

Investigators

Abstract

Wisconsin Opioid Prevention and Treatment Research Network (WI OPTRN) Abstract The opioid overdose crisis remains a major public health emergency, causing over 81,000 deaths in 2023. Emergency departments (EDs) are key settings for intervention, as they frequently treat individuals with opioid overdoses or those at high risk for overdose. Despite this, evidence-based practices such as ED buprenorphine initiation and linkage to ongoing care remain underutilized, representing a significant gap in the continuum of care for individuals with opioid use disorder (OUD). A multidisciplinary team, including addiction specialists, emergency medicine physicians, peer support specialists, human factors engineers, data scientists, and implementation scientists, seeks to address this gap by improving buprenorphine adoption in EDs. The team will use advanced data-driven methods embedded in the electronic health record (EHR), combined with peer-supported care continuity. Surveys of ED clinicians at two University of Wisconsin EDs revealed that clinicians reported that clinical decision support would be a key facilitator for initiating buprenorphine. In response, a clinical pathway for buprenorphine initiation was implemented in 2023, but a follow-up evaluation showed that only 23% patients whose ED visit had a diagnosis of opioid use disorder or opioid overdose received buprenorphine, indicating missed opportunities. To address this, the team proposes an approach integrating artificial intelligence (AI), EHR-embedded clinical decision support (CDS), and peer navigation to improve buprenorphine initiation and linkage to care. The team brings expertise in addiction medicine, implementation science, human-centered design, and clinical informatics, along with input from a Community Advisory Board (CAB) of people with lived experience. The project has three aims. Aim 1 will validate the Opioid AI Screener, a tool previously validated in inpatient settings, to identify patients at high-risk for OUD in the ED with greater than 85% sensitivity and specificity (years 1-4). Aim 2 will involve co-designing and implementing an EHR-embedded CDS to increase buprenorphine initiation in the ED. This system will prompt clinicians when high-risk patients are identified, and offer step-by-step guidance for buprenorphine initiation, management, and automated referral to an outpatient substance use disorder clinic (Years 1-4). Aim 3 will focus on strengthening linkage to community-based OUD care through peer support specialist (PSS) navigation. PSS will conduct outreach, help patients find follow-up care, and address barriers to treatment engagement (Years 1-4). The overarching goal of this project is to create an implementation guide to support wider adoption of buprenorphine initiation in EDs, improving patient outcomes and contributing to broader overdose prevention efforts.