{"doi":"10.1002/emp2.12606","title":"Emergency department‐initiated buprenorphine protocols: A national evaluation","abstract":"Objective Emergency department-initiated buprenorphine (BUP) for opioid use disorder is an evidence-based practice, but limited data exist on BUP initiation practices in real-world settings. We sought to characterize protocols for BUP initiation among a geographically diverse sample of emergency departments (EDs). Methods In December 2020, we reviewed prestudy clinical BUP initiation protocols from all EDs participating in CTN0099 Emergency Department-INitiated bupreNOrphine VAlidaTION (ED-INNOVATION). We abstracted information on processes for identification of treatment-eligible patients, BUP administration, and discharge care. Results All participating ED-INNOVATION sites across 22 states submitted protocols; 31 protocols were analyzed. Identification of treatment-eligible patients: Most EDs 22 (71%) relied on clinician judgment to determine appropriateness of BUP treatment with only 7 (23%) requiring decision support tools or diagnosis checklists. Before BUP initiation, 27 (87%) protocols required a documented Clinical Opiate Withdrawal Scale (COWS) score; 4 (13%) required a clinical diagnosis of withdrawal with optional COWS score. Twenty-seven (87%) recommended a minimum COWS score of 8 for ED-initiated BUP. BUP administration: Initial BUP dose ranged from 2–16 mg (mode = 4). For continued withdrawal symptoms, 27 (87%) protocols recommended an interval of 30–60 minutes between first and second BUP dose. Total BUP dose in the ED ranged from 8 to 32 mg. Discharge care: Twenty-eight (90%) protocols recommended a BUP prescription (mode 16 mg daily) at discharge. Naloxone prescription and/or provision was suggested in 23 (74%) protocols. Conclusions In this geographically diverse sample of EDs, protocols for ED-initiated BUP differed between sites. Future work should evaluate the association between this variation and patient outcomes.","journal":"Journal of the American College of Emergency Physicians Open","year":2021,"id":172099,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":26,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7282,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":31024,"name":"Gail D’Onofrio","orcid":"0000-0002-3833-1871","position":1,"is_corresponding":false},{"id":249729,"name":"David A. Fiellin","orcid":"0000-0002-4006-010X","position":2,"is_corresponding":false},{"id":249730,"name":"E. Jennifer Edelman","orcid":"0000-0002-9375-0489","position":3,"is_corresponding":false},{"id":249719,"name":"Kathryn Hawk","orcid":"0000-0001-7435-5945","position":4,"is_corresponding":false},{"id":677351,"name":"Andrew A. Herring","orcid":null,"position":5,"is_corresponding":false},{"id":591966,"name":"Ryan McCormack","orcid":"0000-0002-7210-4736","position":6,"is_corresponding":false},{"id":371226,"name":"Jeanmarie Perrone","orcid":"0000-0001-7073-9060","position":7,"is_corresponding":false},{"id":249722,"name":"Ethan Cowan","orcid":"0000-0002-7276-0549","position":8,"is_corresponding":false},{"id":707664,"name":"Clara Z. Guo","orcid":"0000-0001-6825-4291","position":0,"is_corresponding":true}],"reference_count":42,"raw_metadata":null,"created_at":"2026-07-18T23:46:37.150824Z","pmid":"34877567","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}