Buprenorphine Induction in Trauma Patients With Opioid Use Disorder — A Single Center Experience?

• Published in: The Journal of surgical research Vol. 301; pp. 686 - 695
• Main Authors: Roth, Erica, Bingaman, Amanda, Stern, Sam, McKeever, Rita, D'Orazio, Joseph, Schlosser, Sean Paul, Cheng, Ke, Zhao, Huaqing, Anderson, Jeffrey H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2024
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Buprenorphine; Buprenorphine - administration & dosage; Buprenorphine - therapeutic use; Female; Humans; Induction; Male; Middle Aged; Narcotic Antagonists - administration & dosage; Narcotic Antagonists - therapeutic use; Opiate Substitution Treatment - methods; Opiate use disorder; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - etiology; Patient Discharge - statistics & numerical data; Retrospective Studies; Trauma; Trauma Centers - statistics & numerical data; Wounds and Injuries - complications; Wounds and Injuries - drug therapy; Young Adult; Opiate use disorder; Buprenorphine; Induction; Trauma
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2024.07.089

Buprenorphine is a Food and Drug Administration-approved therapy for opioid use disorder, with proven efficacy in treatment retention and reduction in opioid use and mortality. Low-dose buprenorphine initiation or microinduction is a novel means of initiation that may allow for an easier transition in patients. Trauma patients have high rates of opioid use disorder and patient directed discharges (PDD). We hypothesized that patients initiated on a buprenorphine microinduction program would have increased protocol completion and fewer PDD compared with patients initiated historically on a traditional induction. Our retrospective cohort study compared buprenorphine microinduction and traditional induction in trauma patients at an urban level one trauma center between December 2020 and June 2022. Patients aged 18-89 y with traumatic injuries who received buprenorphine were included. Our primary outcome was in-hospital protocol completion, defined as reaching 16 mg of buprenorphine within 24 h or a documented stable dose. Statistical analysis was performed using chi-square for categorical variables and two sample t-tests for continuous variables. Ninety-eight patients were included, with 46 initiating with microinduction and 52 initiating with traditional induction. There was no difference in protocol completion, (P = 0.29) and 83% of subjects who started an induction protocol completed it. Those who completed a protocol were more likely to be discharged home (P = 0.0002), had less PDD (P = 0.001), and had an increased likelihood of attending outpatient addiction clinic follow-up (P = 0.038). Regardless of the protocol type, buprenorphine induction can be implemented in trauma patients with high protocol completion rates. In our population, those who complete a protocol had a higher likelihood of discharge home and postdischarge follow-up in addiction medicine clinic.