{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:55:40Z","timestamp":1787320540675,"version":"build-2736575974"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2025,4,8]]},"abstract":"\n Importance<\/jats:title>\n Rates of opioid use disorder (OUD) and associated mortality in the US remain high. Treatment of OUD with buprenorphine reduces morbidity and mortality. There have been national efforts to expand buprenorphine initiation to the emergency department (ED), where many patients with low treatment access seek medical care. Adoption and trends of emergency clinician buprenorphine prescribing are unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To describe emergency clinician buprenorphine initiation for OUD, subsequent prescriptions, and changes over time in California.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Observational retrospective study of buprenorphine prescriptions in the California Controlled Substance Utilization Review and Evaluation System (CURES) database from January 1, 2017, to December 31, 2022. Any patient aged 18 to 79 years with a California zip code who filled a buprenorphine prescription in CURES and their California prescribers were eligible for inclusion.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Buprenorphine prescription by an emergency clinician.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Outcomes included (1) the number of patients prescribed buprenorphine; (2) the number of clinicians prescribing buprenorphine; (3) the number and characteristics of buprenorphine prescriptions; (4) the percentage of emergency clinician buprenorphine initiation prescriptions with subsequent linkage to a second prescription and continuous prescriptions, also reported as a continuation ratio; and (5) days and number of initiation prescriptions prior to continuous prescriptions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In this retrospective observational study, 345\u202f024 patients received 3.8 million buprenorphine prescriptions from 21\u202f099 clinicians in California from 2017 to 2022. The mean age of patients at the time of first buprenorphine prescription was 37 years; 8187 (67%) were male. Emergency clinicians increased from 2% (n\u2009=\u200978) to 16% (n\u2009=\u20091789) of buprenorphine prescribers in 2017 and 2022, respectively (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Buprenorphine initiation prescriptions by emergency clinicians increased from 0.1% (n\u2009=\u200953) to 5% (n\u2009=\u20094493) of all initiation prescriptions in 2017 and 2022, respectively (\n P<\/jats:italic>\n \u2009=\u2009.001). The continuation ratio for patients to receive a second prescription within 40 days of an ED initiation was 2.8 (10\u202f823\/3916). The continuation ratio for patients to start 180 days or more of continuous prescriptions within 40 days of ED buprenorphine initiation was 18.3 (10\u202f823\/593) and 9.1 within 1 year (5989\/655 [2017-2021 data]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n These findings suggest increasing prescription of buprenorphine for OUD by California emergency clinicians from 2017 to 2022, with approximately 1 in 9 patients going on to receive continuous buprenorphine prescriptions within 1 year.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2024.27976","type":"journal-article","created":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T11:00:32Z","timestamp":1739962832000},"page":"1232","source":"Crossref","is-referenced-by-count":19,"title":["Emergency Clinician Buprenorphine Initiation, Subsequent Prescriptions, and Continuous Prescriptions"],"prefix":"10.1001","volume":"333","author":[{"given":"Annette M.","family":"Dekker","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, David Geffen School of Medicine, University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Schriger","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, David Geffen School of Medicine, University of California, Los Angeles"},{"name":"Associate Editor, JAMA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew A.","family":"Herring","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Highland General Hospital\u2013Alameda Health System, Oakland, California"},{"name":"Bridge Center, Public Health Institute, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Samuels","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, David Geffen School of Medicine, University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"joi240161r3","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.annemergmed.2019.04.020","article-title":"One-year mortality of patients after emergency department treatment for nonfatal opioid overdose.","volume":"75","author":"Weiner","year":"2020","journal-title":"Ann Emerg Med"},{"issue":"2","key":"joi240161r4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002207.pub4","article-title":"Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.","volume":"2014","author":"Mattick","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"issue":"9","key":"joi240161r5","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1001\/jamapsychiatry.2021.0976","article-title":"Association of opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence: a systematic review and meta-analysis.","volume":"78","author":"Santo","year":"2021","journal-title":"JAMA Psychiatry"},{"issue":"3","key":"joi240161r6","doi-asserted-by":"publisher","first-page":"137","DOI":"10.7326\/M17-3107","article-title":"Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study.","volume":"169","author":"Larochelle","year":"2018","journal-title":"Ann Intern Med"},{"issue":"2","key":"joi240161r7","doi-asserted-by":"publisher","first-page":"e1920622","DOI":"10.1001\/jamanetworkopen.2019.20622","article-title":"Comparative effectiveness of different treatment pathways for opioid use disorder.","volume":"3","author":"Wakeman","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"9","key":"joi240161r8","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1111\/add.14991","article-title":"Opioid agonist treatment and fatal overdose risk in a state-wide US population receiving opioid use disorder services.","volume":"115","author":"Krawczyk","year":"2020","journal-title":"Addiction"},{"issue":"21","key":"joi240161r10","doi-asserted-by":"publisher","first-page":"1822","DOI":"10.1001\/jama.2024.16954","article-title":"Buprenorphine\/naloxone vs methadone for the treatment of opioid use disorder.","volume":"332","author":"Nosyk","year":"2024","journal-title":"JAMA"},{"issue":"1","key":"joi240161r11","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1001\/jamapsychiatry.2022.3673","article-title":"Racial and ethnic disparities in buprenorphine treatment duration in the US.","volume":"80","author":"Dong","year":"2023","journal-title":"JAMA Psychiatry"},{"key":"joi240161r12","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103786","article-title":"Has the treatment gap for opioid use disorder narrowed in the US? a yearly assessment from 2010 to 2019.","volume":"110","author":"Krawczyk","year":"2022","journal-title":"Int J Drug Policy"},{"issue":"10","key":"joi240161r13","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1377\/hlthaff.2023.00205","article-title":"Racial and ethnic disparities in buprenorphine receipt among medicare beneficiaries, 2015-19.","volume":"42","author":"Miles","year":"2023","journal-title":"Health Aff (Millwood)"},{"issue":"19","key":"joi240161r14","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1056\/NEJMsa2212412","article-title":"Racial inequality in receipt of medications for opioid use disorder.","volume":"388","author":"Barnett","year":"2023","journal-title":"N Engl J Med"},{"issue":"9","key":"joi240161r15","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1001\/jama.2024.11977","article-title":"major gaps in the cascade of care for opioid use disorder: implications for clinical practice.","volume":"332","author":"Arwady","year":"2024","journal-title":"JAMA"},{"issue":"26","key":"joi240161r16","doi-asserted-by":"publisher","first-page":"2487","DOI":"10.1056\/NEJMp1811988","article-title":"Emergency departments\u2014a 24\/7\/365 option for combating the opioid crisis.","volume":"379","author":"D\u2019Onofrio","year":"2018","journal-title":"N Engl J Med"},{"key":"joi240161r17","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108673","article-title":"Voting with their feet: social factors linked with treatment for opioid use disorder using same-day buprenorphine delivered in California hospitals.","volume":"222","author":"Kalmin","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"3","key":"joi240161r18","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1016\/j.annemergmed.2023.03.025","article-title":"National Institute on Drug Abuse Clinical Trials Network meeting report: advancing emergency department initiation of buprenorphine for opioid use disorder.","volume":"82","author":"Cowan","year":"2023","journal-title":"Ann Emerg Med"},{"issue":"16","key":"joi240161r19","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.1001\/jama.2015.3474","article-title":"Emergency department-initiated buprenorphine\/naloxone treatment for opioid dependence: a randomized clinical trial.","volume":"313","author":"D\u2019Onofrio","year":"2015","journal-title":"JAMA"},{"issue":"11","key":"joi240161r20","doi-asserted-by":"publisher","first-page":"2002","DOI":"10.1111\/add.13900","article-title":"Cost-effectiveness of emergency department-initiated treatment for opioid dependence.","volume":"112","author":"Busch","year":"2017","journal-title":"Addiction"},{"issue":"7","key":"joi240161r21","doi-asserted-by":"publisher","first-page":"e2117128","DOI":"10.1001\/jamanetworkopen.2021.17128","article-title":"High-dose buprenorphine induction in the emergency department for treatment of opioid use disorder.","volume":"4","author":"Herring","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"3","key":"joi240161r22","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.annemergmed.2023.02.013","article-title":"Implementing programs to initiate buprenorphine for opioid use disorder treatment in high-need, low-resource emergency departments: a nonrandomized controlled trial.","volume":"82","author":"McCormack","year":"2023","journal-title":"Ann Emerg Med"},{"issue":"7","key":"joi240161r23","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1007\/s43678-023-00520-3","article-title":"Buprenorphine\/naloxone initiation and referral as a quality improvement intervention for patients who live with opioid use disorder: quantitative evaluation of provincial spread to 107 rural and urban Alberta emergency departments.","volume":"25","author":"Stone","year":"2023","journal-title":"CJEM"},{"issue":"1","key":"joi240161r24","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.53771","article-title":"Emergency department access to buprenorphine for opioid use disorder.","volume":"7","author":"Herring","year":"2024","journal-title":"JAMA Netw Open"},{"key":"joi240161r25","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadr.2023.100191","article-title":"Emergency-department initiated buprenorphine: impact on quality of life.","volume":"9","author":"Carroll","year":"2023","journal-title":"Drug Alcohol Depend Rep"},{"issue":"3","key":"joi240161r26","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1016\/j.annemergmed.2021.10.005","article-title":"Naloxone and buprenorphine prescribing following US emergency department visits for suspected opioid overdose: August 2019 to April 2021.","volume":"79","author":"Chua","year":"2022","journal-title":"Ann Emerg Med"},{"issue":"3","key":"joi240161r27","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.0245","article-title":"Association between hospital adoption of an emergency department treatment pathway for opioid use disorder and patient initiation of buprenorphine after discharge.","volume":"4","author":"Solomon","year":"2023","journal-title":"JAMA Health Forum"},{"issue":"5","key":"joi240161r28","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1016\/j.annemergmed.2022.01.042","article-title":"Subsequent buprenorphine treatment following emergency physician buprenorphine prescription fills: a national assessment 2019 to 2020.","volume":"79","author":"Stein","year":"2022","journal-title":"Ann Emerg Med"},{"issue":"3","key":"joi240161r30","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.annemergmed.2021.04.023","article-title":"Consensus recommendations on the treatment of opioid use disorder in the emergency department.","volume":"78","author":"Hawk","year":"2021","journal-title":"Ann Emerg Med"},{"key":"joi240161r31","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.ajem.2024.05.015","article-title":"Evaluation of medications used for opioid use disorder in emergency departments: a cross-sectional analysis of the 2020 National Hospital Ambulatory Medical Care Survey.","volume":"82","author":"Lee","year":"2024","journal-title":"Am J Emerg Med"},{"issue":"10","key":"joi240161r32","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.21209","article-title":"Trends in the use of buprenorphine in US emergency departments, 2002-2017.","volume":"3","author":"Rhee","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"6","key":"joi240161r33","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/j.annemergmed.2021.05.024","article-title":"Rapid adoption of low-threshold buprenorphine treatment at California emergency departments participating in the CA Bridge program.","volume":"78","author":"Snyder","year":"2021","journal-title":"Ann Emerg Med"},{"issue":"9","key":"joi240161r34","doi-asserted-by":"publisher","first-page":"874","DOI":"10.2105\/AJPH.2024.307710","article-title":"Scaling emergency department opioid use disorder treatment across California to reduce overdose deaths, 2019-2023.","volume":"114","author":"Samuels","year":"2024","journal-title":"Am J Public Health"},{"issue":"9596","key":"joi240161r36","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"issue":"3","key":"joi240161r40","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.annemergmed.2022.12.004","article-title":"Boarding in US academic emergency departments during the COVID-19 pandemic.","volume":"82","author":"Kilaru","year":"2023","journal-title":"Ann Emerg Med"},{"issue":"5","key":"joi240161r41","doi-asserted-by":"publisher","first-page":"e204561","DOI":"10.1001\/jamanetworkopen.2020.4561","article-title":"Barriers and facilitators to clinician readiness to provide emergency department-initiated buprenorphine.","volume":"3","author":"Hawk","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"9","key":"joi240161r42","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1016\/j.ajem.2019.02.025","article-title":"Barriers and facilitators for emergency department initiation of buprenorphine: a physician survey.","volume":"37","author":"Lowenstein","year":"2019","journal-title":"Am J Emerg Med"},{"issue":"1","key":"joi240161r43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/00952990.2018.1546862","article-title":"Development of a cascade of care for responding to the opioid epidemic.","volume":"45","author":"Williams","year":"2019","journal-title":"Am J Drug Alcohol Abuse"},{"issue":"2","key":"joi240161r44","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1097\/ADM.0000000000001077","article-title":"Thirty-day treatment continuation after audio-only buprenorphine telehealth initiation.","volume":"17","author":"Wunsch","year":"2023","journal-title":"J Addict Med"},{"issue":"1","key":"joi240161r45","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxad013","article-title":"Pandemic telehealth flexibilities for buprenorphine treatment: a synthesis of evidence and policy implications for expanding opioid use disorder care in the United States.","volume":"1","author":"Krawczyk","year":"2023","journal-title":"Health Aff Sch"},{"issue":"10","key":"joi240161r46","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.36914","article-title":"Telemedicine buprenorphine initiation and retention in opioid use disorder treatment for Medicaid enrollees.","volume":"6","author":"Hammerslag","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"5","key":"joi240161r47","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.5852","article-title":"Incidence of treatment for opioid use disorder following nonfatal overdose in commercially insured patients.","volume":"3","author":"Kilaru","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"6","key":"joi240161r48","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.15287","article-title":"Trends and disparities in access to buprenorphine treatment following an opioid-related emergency department visit among an insured cohort, 2014-2020.","volume":"5","author":"Stevens","year":"2022","journal-title":"JAMA Netw Open"},{"key":"joi240161r38","author":"R Core Team","year":"2023"},{"key":"joi240161r1","unstructured":"National Institute on Drug Abuse. Drug overdose death rates. Published 2023. Accessed June 25, 2024. https:\/\/nida.nih.gov\/research-topics\/trends-statistics\/overdose-death-rates"},{"key":"joi240161r2","unstructured":"Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network (DAWN) Findings from Drug-Related Emergency Department Visits, 2021. Published 2022. Accessed November 25, 2023. https:\/\/store.samhsa.gov\/sites\/default\/files\/pep22-07-03-002.pdf"},{"key":"joi240161r9","unstructured":"Predictive policing: don\u2019t even think about it. The Economist. Published July 20, 2013. Accessed December 17, 2020. https:\/\/www.economist.com\/briefing\/2013\/07\/20\/dont-even-think-about-it"},{"key":"joi240161r29","unstructured":"American College of Emergency Physicians. E-QUAL Network Opioid Initiative. Accessed June 25, 2024. https:\/\/www.acep.org\/administration\/quality\/equal\/emergency-quality-network-e-qual\/e-qual-opioid-initiative\/"},{"key":"joi240161r35","unstructured":"State of California Department of Justice Office of the Attorney General. Controlled Substance Utilization Review and Evaluation System. Accessed February 18, 2022. https:\/\/oag.ca.gov\/cures"},{"key":"joi240161r37","unstructured":"Centers for Medicare & Medicaid Services. Quality ID #468 (NQF 3175): continuity of pharmacotherapy for opioid use disorder (OUD). MIPS Clinical Quality Measures (CQMS). Published 2019. Accessed April 21, 2024. https:\/\/qpp.cms.gov\/docs\/QPP_quality_measure_specifications\/CQM-Measures\/2019_Measure_468_MIPSCQM.pdf"},{"key":"joi240161r39","doi-asserted-by":"crossref","unstructured":"de Vries? P. ggsankeyfier: create Sankey and alluvial diagrams using \u201cggplot2.\u201d Accessed January 15, 2025. https:\/\/github.com\/pepijn-devries\/ggsankeyfier","DOI":"10.32614\/CRAN.package.ggsankeyfier"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2830615\/jama_dekker_2025_oi_240161_1743517541.83668.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T11:46:43Z","timestamp":1744112803000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2830615"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,8]]},"references-count":48,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2025,4,8]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2024.27976","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4,8]]}}}