Original Research by the Highland Team

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.

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.

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).

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.

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.

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

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.

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

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.

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

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.