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Original Research by the Highland Team

December 1, 2022

A Neuropharmacological Model to Explain Buprenorphine Induction Challenges

We present data from clinical studies of buprenorphine induction and propose a neuropharmacologic working model, which posits that acute clinical success of buprenorphine induction (achieving a positive agonist-to-withdrawal balance) is a nonlinear outcome of the opioid balance at the time of initial buprenorphine dose and mu-opioid–receptor affinity, lipophilicity, and mu-opioid–receptor intrinsic efficacy (the “ALE value”) of the prior opioid.

November 17, 2022

Effectiveness of Substance Use Navigation for Emergency Department Patients with Substance Use Disorders: An Implementation Study

A whole person care-informed intervention delivered by SUNs for ED patients with substance use disorders was strongly associated with higher engagement rates in addiction treatment after discharge.

December 8, 2021

The Social Context of Unhealthy Alcohol Use Among Emergency Department Patients: A Cross Sectional Study

Housing status and additional social determinants of health are important data for clinicians and policy makers to design and implement effective interventions for emergency department (ED) patients with unhealthy alcohol use (UAU).

December 1, 2021

Rapid Adoption of Low-Threshold Buprenorphine Treatment at California Emergency Departments Participating in the CA Bridge Program

Low-threshold ED buprenorphine treatment implemented with a harm reduction approach and active navigation to outpatient addiction treatment was successful in achieving buprenorphine treatment for opioid use disorder in diverse California communities.

December 1, 2021

Implementation of Oral and Extended-Release Naltrexone for the Treatment of Emergency Department Patients With Moderate to Severe Alcohol Use Disorder: Feasibility and Initial Outcomes

We implemented a clinical protocol for ED patients with moderate to severe alcohol use disorder using oral naltrexone and extended-release intramuscular naltrexone together with substance use navigation. Identification of alcohol use disorder, a brief intervention, and initiation of naltrexone resulted in a 15% follow-up rate in formal addiction treatment.

November 16, 2021

Synergistic Effect of Ketamine and Buprenorphine Observed in the Treatment of Buprenorphine Precipitated Opioid Withdrawal in a Patient With Fentanyl Use

This single case observation raises important questions about the potential therapeutic role of ketamine as a treatment for BPOW.

July 15, 2021

High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder

In this case series of 579 cases, 54 clinicians followed a high-dose buprenorphine (monoproduct) protocol. There were no documented episodes of respiratory depression or excessive sedation, and precipitated withdrawal was rare (0.8% of cases) and was not associated with dosing.

May 1, 2021

Treatment of opioid and alcohol withdrawal in a cohort of emergency department patients

In this study we examine a cohort of patients treated with buprenorphine and phenobarbital or benzodiazepines for co-occurring opioid and alcohol withdrawal.

May 1, 2021

Voting with their feet: Social factors linked with treatment for opioid use disorder using same-day buprenorphine delivered in California hospitals

Our study found that a regionally diverse coalition of hospitals implemented a trauma-informed, low-threshold buprenorphine treatment program for patients with Medicaid, unstable housing, and co-methamphetamine use.

December 27, 2020

Sharp decline in hospital and emergency department initiated buprenorphine for opioid use disorder during COVID-19 state of emergency in California

The COVID-19 California statewide shutdown was associated with an abrupt and large decrease in the progress toward expanded access to OUD treatment.

January 4, 2019

Managing Opioid Withdrawal in the Emergency Department With Buprenorphine

The best-practice approach supports the administration of buprenorphine in the ED, with adequate titration to both quell withdrawal and mitigate the risk of opioid use after discharge.

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