Expanding Access to Low-Barrier Buprenorphine in Acute Care Settings Through Enhanced Best Practice Model Fidelity and Prehospital Innovations to Address the Opioid Overdose Crisis

University Of Minnesota, Minneapolis MN

Investigators

Abstract

ABSTRACT Project Title: Expanding Low-Barrier Buprenorphine Initiation and Post-Discharge Engagement in Emergency and Prehospital Settings Background: The opioid crisis continues to pose a significant public health challenge, with opioid- related overdose stubbornly high across the U.S. despite the availability of evidence-based treatment options. Emergency departments (EDs) and emergency medical services (EMS) serve as critical intervention points for patients experiencing opioid-related crises. However, despite strong evidence supporting ED-initiated medication for opioid use disorder (MOUD), implementation remains limited due to provider hesitancy, institutional barriers, and gaps in post-discharge care. This project seeks to address these challenges by integrating structured, high-dose buprenorphine induction across EMS and ED settings while ensuring sustained post-discharge engagement through a multidisciplinary mobile outreach team. Objectives: This study will evaluate the impact of a structured MOUD expansion model that spans prehospital, acute care, and community settings. The primary objectives are to: 1. Increase buprenorphine administration in ED and EMS settings to improve rapid access to MOUD. 2. Enhance provider adoption of high-dose buprenorphine induction protocols through structured training and technical assistance. 3. Improve patient retention at 7-day and 30-day post-discharge intervals via proactive mobile outreach and linkage to outpatient treatment. 4. Decrease overall ED utilization among patients receiving buprenorphine, reducing avoidable healthcare encounters and hospital burden. Methods: This study employs a mixed-methods evaluation framework, integrating both quantitative and qualitative assessments. Electronic health records (EHRs) will track buprenorphine administration rates, help monitor retention in treatment, and measure changes to ED utilization and hospital re-admissions. Provider surveys and structured interviews will assess confidence and knowledge in high-dose induction protocols. The ED-IMAT tool will systematically evaluate institutional readiness, training gaps, and care linkage challenges. Qualitative insights from Extension for Community Healthcare Outcomes (ECHO) sessions will further inform implementation barriers and real-time adaptation strategies. Significance: By embedding a sustainable, data-driven MOUD expansion model within acute and prehospital care settings, this initiative directly supports Healthy People 2030 objectives to increase the proportion of individuals receiving MOUD and reduce opioid-related mortality. Findings will contribute to national efforts to scale ED and EMS-based addiction treatment, inform state and municipal policy, and establish a replicable framework for integrating MOUD into emergency care workflows. Impact: This project aims to transform opioid overdose response by shifting from a reactive to a proactive, patient-centered model of care. Through structured capacity-building, real-time technical assistance, and post-discharge navigation, this initiative will optimize MOUD retention, improve health outcomes, and reduce opioid-related harms at the population level.