Article Figures & Tables
Tables
Characteristic No. (%) of respondents
n = 652*Gender Female 246 (37.7) Male 402 (61.7) Other 4 (0.6) Age, yr < 40 260 (39.9) 40–50 219 (33.6) > 50 173 (26.5) Province British Columbia (10 ED groups working in 14 EDs) 290 (44.5) Alberta (3 ED groups working in 4 EDs) 94 (14.4) Saskatchewan (1 ED group working in 3 EDs) 41 (6.3) Ontario (3 ED groups working in 4 EDs) 102 (15.6) Quebec (4 ED groups working in 5 EDs) 100 (15.3) New Brunswick (1 ED group working in 4 EDs) 25 (3.8) Practice setting population > 100 000 563 (86.4) < 100 000 89 (13.7) Practice setting type Academic hospitals (emergency medicine residency host sites) 486 (74.2) Community-based hospitals 169 (25.8) ED group size* < 30 group members 182 (27.9) 31–49 group members 289 (44.3) ≥ 50 group members 181 (27.8) Years in practice ≤ 5 171 (26.2) 6–10 151 (23.2) > 10 330 (50.6) Certification (n = 651) CCFP (EM) 342 (52.5) FRCPC 243 (37.3) ABEM and other non-Canadian EM 51 (7.8) CCFP and other FM 15 (2.3) Survey modality Online 252 (38.7) Paper 400 (61.4) Language English 553 (84.8) French 99 (15.2) Note: ABEM = American Board of Emergency Medicine certification, CCFP (EM) = Certification in the College of Family Physicians of Canada (Emergency Medicine), CCFP = Certification in the College of Family Physicians of Canada (without additional emergency certification), ED = emergency department, EM = emergency medicine, FRCPC = Fellow of the Royal College of Physicians of Canada, other FM = other family medicine certification.
↵* Number of staff physicians not including locums (average group size 36.3, range 21–67).
Characteristic No. of respondents % of respondents (95% CI) Range across physician groups, %* Frequency of contact with patients who use opioids Treat patients who use illicit opioids at least once per shift (n = 648) 384 59.3† (55.5–63.1) 0.0–95.7 Treat patients who use illicit opioids at least once per month (n = 648) 595 91.8† (89.7–93.9) 24.1–100.0 BUP practice, past Initiate ED or home-based BUP at least once per month (n = 649) 161 24.8‡ (21.5–28.1) 0.0–76.7 Initiate ED or home-based BUP at least once per year (n = 649) 358 51.3‡ (55.2–59.0) 3.6–100.0 Initiated ED or home-based BUP at least once in career (n = 649) 416 64.1‡ (60.4–67.8) 7.1–100.0 Prescribed BUP for home initiation at least once in career (n = 606) 233 38.4 (34.6–42.3) 0.0–79.1 Ordered BUP for ED initiation at least once in career (n = 649) 408 62.9 (59.1–66.6) 7.1–100.0 BUP practice, planned Would use ED BUP for opioid withdrawal (n = 649) 412 63.5 (59.8–67.2) 3.4–100.0 Would prescribe BUP for home use (n = 648) 223 34.4 (30.7–38.1) 0.0–72.1 Availability of resources Timely access to addictions specialist (n = 646) 424 65.6 (62.0–69.3) 22.5–100.0 Clinical pathway for BUP initiation (n = 646) 389 60.2 (56.4–64.0) 5.1–95.3 BUP available to order (n = 640) 511 79.8 (76.7–83.0) 7.7–100.0 BUP to-go packages for home initiation (n = 637) 222 34.9 (31.1–38.6) 0.0–95.5 Peer support workers for patients with opioid use disorder (n = 639) 245 38.3 (34.6–32.1) 6.7–92.3 Low-barrier clinics for ongoing care (n = 639) 481 75.3 (71.9–78.6) 11.1–100.0 Note: BUP = buprenorphine–naloxone, CI = confidence interval, ED = emergency department.
↵* Range from the ED group with the lowest positive response rate to the ED group with the highest positive response rate.
↵† The sum of these percentages is > 100% because at least once per month includes at least once per shift.
↵‡ The sum of these percentages is > 100% because at least once in career includes both at least once per year and at least once per month, and at least once per year includes at least once per month.
- Table 3:
Respondents’ willingness to administer interventions in the ED for patients with opioid use disorder and their confidence in doing so
Characteristic No. of respondents % of respondents (95% CI) Range across physician groups, %* Willingness† to provide the following ED interventions Refer to detoxification program or addictions clinic (n = 644) 617 95.8 (94.3–97.4) 82.7–100.0 Provide take-home naloxone kits (n = 643) 596 92.7 (90.7–94.7) 69.0–100.0 Administer brief screening regarding unhealthy substance use (n = 645) 517 80.2 (77.1–83.2) 62.1–93.0 Refer to needle exchange program (n = 633) 500 79.0 (75.8–82.2) 58.6–91.7 Initiate ED-based BUP (n = 636) 438 68.9 (65.3–72.4) 24.1–97.6 Prescribe or dispense BUP for home start (n = 627) 341 54.4 (50.5–58.3) 15.8–90.7 Confidence† in providing the following ED interventions Refer to detoxification program or addictions clinic (n = 643) 586 91.1 (89.9–93.3) 82.8–100.0 Provide take-home naloxone kits (n = 643) 602 93.6 (91.7–95.5) 69.0–100.0 Administer brief screening regarding unhealthy substance use (n = 640) 519 81.1 (78.1–84.1) 60.0–100.0 Refer to needle exchange program (n = 630) 463 73.5 (70.0–76.9) 55.6–87.5 Initiate ED-based BUP (n = 630) 400 63.5 (59.7–67.3) 31.0–97.7 Prescribe or dispense BUP for home start (n = 623) 297 47.7 (43.7–51.6) 24.1–88.4 Confidence† in the following aspects of ED BUP initiation Screen patients (n = 626) 327 52.2 (48.3–56.2) 20.7–86.0 Conduct discussion regarding ED initiation (n = 627) 357 56.9 (53.1–60.8) 22.2–90.7 Assess withdrawal severity for appropriateness of initiation (n = 625) 362 57.9 (54.0–61.8) 21.6–93.0 Administer BUP and provide ongoing prescription (n = 621) 332 53.5 (49.5–57.4) 16.7–90.7 Discharge with prescription (n = 614) 283 46.1 (42.1–50.0) 13.8–93.0 Arrange appropriate follow-up (n = 616) 348 56.5 (52.6–60.4) 17.6–93.0 - Table 4:
Barriers, facilitators and perceived impact of initiation of buprenorphine–naloxone in the emergency department
Characteristic No. of respondents % of respondents (95% CI) Range across physician groups, %* Barriers rated as “very significant”† Lack of adequate training (n = 631) 367 58.2 (54.3–62.0) 14.0–95.2 Lack of time during clinical encounter (n = 625) 345 55.2 (51.2–59.1) 37.7–79.3 Lack of physical care space for initiation (n = 601) 298 49.6 (45.6–53.6) 0.0–69.4 Lack of adequate outpatient follow-up options (n = 598) 252 42.1 (38.2–46.1) 0.0–96.6 Lack of hospital or ED administrative support (n = 602) 220 36.5 (32.7–40.4) 0.0–89.3 Limited knowledge of research (n = 607) 207 34.1 (30.3–37.9) 4.7–58.3 Facilitators rated as having “strong impact”‡ Availability of specialized staff (n = 630) 589 93.5 (91.6–95.4) 75.0–100.0 Availability of clinical pathways (n = 624) 573 91.8 (89.7–94.0) 75.0–95.5 ED BUP initiation is common local practice (n = 628) 541 86.1 (83.4–88.9) 58.8–100.0 Evidence that BUP decreases overdose mortality (n = 623) 535 85.9 (83.1–88.6) 64.3–100.0 Timely access to addictions specialist (n = 627) 532 84.9 (82.0–87.7) 64.3–100.0 Supportive recommendations from professional organization (n = 626) 507 81.0 (77.9–84.1) 53.3–100.0 Support from ED nursing staff (n = 628) 511 81.4 (78.3–84.4) 58.3–100.0 Local leaders who recommend ED BUP intitiation (n = 616) 456 74.0 (70.6–77.5) 41.7–96.2 Perceived public health effect of ED BUP initiation§ Decrease in deaths from opioid overdose (n = 634) 506 79.8 (76.7–82.9) 56.3–96.3 Decrease in 911 calls for opioid overdose (n = 632) 387 61.2 (57.4–65.0) 36.8–85.0 Decrease in ED visits for opioid overdose (n = 634) 379 59.8 (56.0–63.6) 36.0–92.3 Decrease in overall opioid use (n = 632) 324 51.3 (47.4–55.2) 21.7–69.2 Note: BUP = buprenorphine–naloxone, CI = confidence interval, ED = emergency department.
↵* Range from the ED group with the lowest positive response rate to the ED group with the highest positive response rate.
↵† “Very significant” is a score of at least 4 on a 1–5 scale.
↵‡ “Strong impact” is a score of at least 7 on a 1–10 scale.
↵§ “Decrease” is a score of at least 4 on a 1–5 scale.
- Table 5:
Respondents’ attitudes toward interventions for patients with opioid use disorder
Characteristic No. of respondents % of respondents (95% CI) Range across physician groups, %* Respondent agreement that emergency physicians have a “major” level of responsibility† to perform the following interventions in the ED Referral to detoxification programs or addictions services (n = 629) 513 81.6 (78.5–84.6) 60.0–100.0 Provision of take-home naloxone kits (n = 629) 512 81.4 (78.3–84.4) 52.0–100.0 Screening and counselling for interpersonal violence (n = 626) 431 68.9 (65.2–72.5) 47.6–90.0 Screening and education regarding substance use (n = 626) 429 68.5 (64.9–72.2) 58.6–83.7 BUP initiation for opioid use disorder (n = 626) 402 64.2 (60.5–68.0) 31.0–90.7 Referral to needle exchange program (n = 618) 359 58.1 (54.2–62.0) 35.7–76.9 Counselling for smoking cessation (n = 622) 262 42.1 (38.2–46.0) 20.0–61.8 Screening for human immunodeficiency virus (n = 619) 239 38.6 (34.8–42.5) 13.0–74.4 Respondent agreement‡ with the following statements I feel that I am able to work with PWUD as well as other client groups (n = 627) 414 66.0 (62.3–69.7) 20.7–88.9 One can get satisfaction from working with PWUD (n = 626) 400 63.9 (60.1–67.7) 35.0–76.3 It is rewarding to work with PWUD (n = 628) 233 37.1 (33.3–40.9) 13.8–60.9 I feel I can understand PWUD (n = 623) 231 37.1 (33.3–40.9) 11.8–60.0 I feel that there is little I can do to help PWUD (n = 625) 231 37.0 (33.2–40.8) 14.0–82.8 I feel that I am a failure with PWUD (n = 615) 159 25.9 (22.4–29.3) 5.0–79.3 I often feel uncomfortable working with PWUD (n = 595) 105 17.6 (14.6–20.7) 0.0–42.9 I have less respect for PWUD than other patients (n = 602) 104 17.3 (14.2–20.3) 4.9–25.9 Composite self-efficacy at least 4 on 1–5 scale (n = 576) 211 36.6 (32.7–40.6) 0.0–66.7 Respondent agreement§ with the following ASAM statements Addiction is influenced by psychological and environmental factors (n = 632) 615 97.3 (96.0–98.6) 88.0–100.0 Addiction is a chronic medical illness similar to asthma, diabetes and hypertension (n = 629) 526 83.6 (80.7–86.5) 69.6–100.0 Addiction is the result of changes in brain neurocircuitry (n = 624) 506 81.1 (78.0–84.2) 54.3–95.2 Agreement with all 3 statements (n = 621) 457 73.6 (70.1–77.1) 48.6–85.7 Note: ASAM = American Society of Addiction Medicine, BUP = buprenorphine–naloxone, CI = confidence interval, ED = emergency department, PWUD = people who use drugs.
↵* Range from the ED group with the lowest positive response to the ED group with the highest positive response.
↵† Score of at least 7 on a 1–10 scale.
↵‡ Score of at least 5 on a 1–7 scale.
↵§ Score of at least 4 on a 1–5 scale.