Patient Perspectives on Offers of Buprenorphine in the Emergency Department
5 affiliations
- 1Department of Emergency Medicine, Medical University of South Carolina, Charleston
- 2Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston
- 3Mercy Health, Youngstown, Ohio
- 4Department of Medicine and Emergency Medicine, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville
- 5Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan
Abstract
Importance: Buprenorphine reduces mortality in opioid use disorder (OUD), and emergency department–initiated buprenorphine (EDIB) doubles 30-day treatment retention, yet many patients decline EDIB when offered. Patient-driven factors limiting uptake are not well characterized.
Objective: To identify factors associated with patients accepting or declining EDIB.
Design, Setting, and Participants: Convergent parallel mixed-methods qualitative study conducted from May 1 to December 31, 2023, with data analyses performed from March 2025 to April 2026, at 4 emergency departments within the National Drug Abuse Treatment Clinical Trials Network (CTN) in South Carolina, Michigan, and Ohio. Adult patients (aged ≥18 years) with OUD who were offered buprenorphine by clinical staff were eligible; prisoners and patients concurrently enrolled in other CTN trials of OUD treatment or overdose prevention were excluded.
Main Outcomes and Measures: The main outcomes were acceptance or declination of EDIB; validated measures of treatment readiness (Stages of Change Readiness and Treatment Engagement Scale [SOCRATES]), cultural mistrust, perceived discrimination, and social needs; and qualitative interview themes regarding reasons for accepting or declining buprenorphine.
Results: Eighty-two participants completed the study (median [IQR] age, 38 [31-53.5] years; 52 male [64%]). Overall, 19 participants (23%) declined buprenorphine. Among 54 participants who described reasons for accepting EDIB, motivators for accepting EDIB included assistance with opioid withdrawal (37 [69%]), desire to be substance free (21 [39%]), wanting to return to a “normal life” (15 [28%]), fear of overdose or death (13 [24%]), and caring for children (7 [13%]). Among 22 participants who described reasons for declining EDIB, barriers included concern about precipitated withdrawal or adverse effects (11 [50%]), not wanting to be physically dependent on buprenorphine (7 [32%]), and housing and logistical barriers (5 [23%]). SOCRATES treatment readiness (1-5 scale) was similar in patients who accepted (mean [SD] score, 4.11 [0.55]) and declined (mean [SD] score, 4.05 [0.50]) EDIB.
Conclusions and Relevance: In this mixed-methods qualitative study of adult ED patients with OUD who were offered buprenorphine, declination was driven less by low treatment readiness than by specific, addressable concerns: precipitated withdrawal, physical dependence, and housing and logistical barriers. Targeted interventions addressing these concerns may increase uptake of this life-saving treatment.
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BibTeX
@article{jennings2026patient,
title = {{Patient Perspectives on Offers of Buprenorphine in the Emergency Department}},
author = {Lindsey K. Jennings and Kelly Barth and Suzanne Lane and Alyssa Rafferty and Carrie Papa and Louise Haynes and Susan Sonne and Heather McCowin and Phillip Moschella and Alain H. Litwin and Jacob J. Manteuffel and Kathleen Brady and Angela Moreland},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.37671},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854874},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Patient Perspectives on Offers of Buprenorphine in the Emergency Department
AU - Lindsey K. Jennings
AU - Kelly Barth
AU - Suzanne Lane
AU - Alyssa Rafferty
AU - Carrie Papa
AU - Louise Haynes
AU - Susan Sonne
AU - Heather McCowin
AU - Phillip Moschella
AU - Alain H. Litwin
AU - Jacob J. Manteuffel
AU - Kathleen Brady
AU - Angela Moreland
PY - 2026
DA - 2026/10/06
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.37671
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854874
AB - Importance: Buprenorphine reduces mortality in opioid use disorder (OUD), and emergency department–initiated buprenorphine (EDIB) doubles 30-day treatment retention, yet many patients decline EDIB when offered. Patient-driven factors limiting uptake are not well characterized. Objective: To identify factors associated with patients accepting or declining EDIB. Design, Setting, and Participants: Convergent parallel mixed-methods qualitative study conducted from May 1 to December 31, 2023, with data analyses performed from March 2025 to April 2026, at 4 emergency departments within the National Drug Abuse Treatment Clinical Trials Network (CTN) in South Carolina, Michigan, and Ohio. Adult patients (aged ≥18 years) with OUD who were offered buprenorphine by clinical staff were eligible; prisoners and patients concurrently enrolled in other CTN trials of OUD treatment or overdose prevention were excluded. Main Outcomes and Measures: The main outcomes were acceptance or declination of EDIB; validated measures of treatment readiness (Stages of Change Readiness and Treatment Engagement Scale [SOCRATES]), cultural mistrust, perceived discrimination, and social needs; and qualitative interview themes regarding reasons for accepting or declining buprenorphine. Results: Eighty-two participants completed the study (median [IQR] age, 38 [31-53.5] years; 52 male [64%]). Overall, 19 participants (23%) declined buprenorphine. Among 54 participants who described reasons for accepting EDIB, motivators for accepting EDIB included assistance with opioid withdrawal (37 [69%]), desire to be substance free (21 [39%]), wanting to return to a “normal life” (15 [28%]), fear of overdose or death (13 [24%]), and caring for children (7 [13%]). Among 22 participants who described reasons for declining EDIB, barriers included concern about precipitated withdrawal or adverse effects (11 [50%]), not wanting to be physically dependent on buprenorphine (7 [32%]), and housing and logistical barriers (5 [23%]). SOCRATES treatment readiness (1-5 scale) was similar in patients who accepted (mean [SD] score, 4.11 [0.55]) and declined (mean [SD] score, 4.05 [0.50]) EDIB. Conclusions and Relevance: In this mixed-methods qualitative study of adult ED patients with OUD who were offered buprenorphine, declination was driven less by low treatment readiness than by specific, addressable concerns: precipitated withdrawal, physical dependence, and housing and logistical barriers. Targeted interventions addressing these concerns may increase uptake of this life-saving treatment.
SN - 2574-3805
ER -