Leadership Group: Andrew Kestler (University of British Columbia, BC); Kathryn Dong (University of Alberta, AB)
Research Coordinator: Bluma Blake Kleiner (Centre de recherche du CHUM, QC)
Objectives
The purpose of this thematic area is to enhance access to opioid agonist treatment (OAT) in emergency departments by reviewing the current landscape of this intervention, and by developing educational resources to address the gaps, attitudes, knowledge, and skills of emergency physicians in providing quality care to people who use opioids.
Project Components
Emergency Department Initiation of Opioid Agonist Treatment for Patients with Opioid Dependence: A Rapid Systematic Review
Given the recent interest in OAT initiation in emergency departments to address the opioid crisis in Canada, we identified and synthesized the existing literature to better understand this intervention and to provide critical information to audiences engaged in harm reduction research, practice, and policy.
The systematic review was published in June, 2020.
Buprenorphine–naloxone practice and attitudes in 22 Canadian emergency physician groups: a cross-sectional survey
While the opioid crisis is a complex issue, there are a number of steps emergency physicians can take to assist patients at risk, including initiating OAT in the emergency department. However, the level of comfort and willingness of emergency physicians to initiate OAT remains unclear. A survey was administered to emergency physicians across British Columbia, Alberta, Ontario, and Quebec. Objectives include:
- Identify emergency physicians’ attitudes towards initiating OAT in emergency departments, identify current prescribing patterns amongst emergency physicians (i.e. frequency of prescribing buprenorphine/naloxone), identify emergency physicians’ perceived barriers and facilitators in initiating OAT, identify emergency physicians’ awareness of resources (published guidelines, accessing addictions specialist, etc.) to ensure appropriate management and provision of OAT,
- The results were used to identify sites to be selected for the focus groups below.
Emergency physician perspectives on initiating buprenorphine/naloxone in the emergency department: A qualitative study
Differing views, attitudes, and accessibility of OAT have resulted in different stages of implementation across Canadian emergency departments. To support and facilitate emergency departments in their implementation process, we conducted phone interviews with emergency physicians across Canada who were interested in OAT implementation. The phone interviews included discussions from the preliminary results of the emergency physician groups survey. The results describe the current context surrounding implementation of OAT in emergency departments nationally and provide key recommendations for consideration.
- Poster presented at CSAM 2019
- The article was published in 2021
Development of a Canadian emergency department checklist to improve care for people who use opioids: a modified Delphi study
Emergency departments play a critical role in identifying and initiating treatment for people who use opioids, but emergency department care for these patients varies widely across Canada. Our modified Delphi study aimed to develop a consensus-based checklist of good practices for this group at high-risk of short-term mortality post-discharge. We recruited panelists from a Canada-wide collaborator meeting on the initiation of OAT in emergency departments to participate in two Delphi consensus rounds. Our final 13-item checklist has received preliminary support from the Addictions Committee of the Canadian Association of Emergency Physicians (CAEP).
More information on the Delphi study and the final 13-item checklist may be found below.
Implementation and evaluation of best practices checklist for patients who use opioids in emergency departments across Canada
The CAEP/CRISM team is now accepting applications from EDs that have the capacity to implement all or part of the best practices checklist, including providing evaluation data to measure the success of the checklist towards improving care for people with OUD. Approximately ten emergency departments across Canada will be selected to receive up to a maximum of $10,000 to conduct implementation and evaluation activities. Emergency departments selected to pilot the best practices checklist will be asked to provide baseline and post-implementation data on OUD services provided. Participating EDs will receive logistical support from CRISM and expert advice from the CAEP/CRISM team. We intend to involve sites at a wide variety of stages of engagement with substance use/harm reduction policy and practice, so please consider applying!
The deadline to apply is June 30, 2025, at 23H59 EST.
