{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T11:39:46Z","timestamp":1792496386828,"version":"4.5.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"\n Importance<\/jats:title>\n Extended-release injectable buprenorphine may expand the reach of initiating medications for opioid use disorder in high-risk and hard-to-reach individuals who visit the emergency department (ED) and can be administered in low levels of withdrawal.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the effect of ED-initiated 7-day extended-release injectable buprenorphine vs sublingual buprenorphine on treatment engagement at 7 days.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Multicenter randomized clinical trial enrolling adult patients presenting to the ED with untreated opioid use disorder and a Clinical Opiate Withdrawal Scale (COWS) score of 4 or higher across 29 EDs in the US from July 12, 2020, to August 21, 2024. Final follow-up was completed on October 24, 2024.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients were randomized to receive a 24-mg injection of extended-release buprenorphine (equivalent to 16 mg\/d) or sublingual buprenorphine, which included either self-administration instructions if the COWS score was less than 8 or administration of 8 mg of sublingual buprenorphine in the ED if the COWS score was 8 or higher. All sublingual buprenorphine group patients received a 7-day prescription for 16 mg\/d. Both groups were provided referral for ongoing medication with a scheduled appointment within 7 days.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Engagement in opioid use disorder treatment on day 7 was the primary outcome. Secondary outcomes included engagement at 30 days, precipitated withdrawal and overdose events, craving scores, days of illicit opioid use, and patient satisfaction with treatment.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 2000 patients randomized, 6 who were enrolled twice were excluded, resulting in 991 in the extended-release group and 1003 in the sublingual group. The median age was 37 (IQR, 30-47) years, 68% were male, 31% had an initial COWS score of 4 to 7, and 76% tested positive for fentanyl. The adjusted proportion of engagement in opioid use disorder treatment at 7 days was 40.5% with extended-release buprenorphine vs 38.5% with sublingual buprenorphine (adjusted difference, 1.6%; 95% CI, \u22122.8% to 6.0%). Engagement at 30 days was similar, with adjusted proportions of 43.8% with extended-release buprenorphine vs 44.9% with sublingual buprenorphine (adjusted difference, \u22121.5%; 95% CI, \u22126.2% to 3.2%). Precipitated withdrawal was rare: 6 (0.6%) with extended-release buprenorphine and 8 (0.8%) with sublingual buprenorphine. Overdose events within 30 days occurred in 18 participants (2.3%) in each group. Patients receiving extended-release buprenorphine reported lower mean craving scores at 7 days vs those receiving sublingual buprenorphine (scale, 0-100; mean score, 26.5 vs 30.2, respectively; adjusted mean difference, \u22123.85; 95% CI, \u22127.08 to \u22120.63), fewer days of illicit opioid use in the past 7 days (adjusted ratio of means, 0.77; 95% CI, 0.68-0.95), and better treatment satisfaction scores (scale, 1-5; adjusted mean difference, 0.13; 95% CI, 0.01-0.25).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n No difference was detected in opioid use disorder treatment engagement on day 7 between the 7-day extended-release and sublingual buprenorphine groups. Both buprenorphine formulations were well tolerated; precipitated withdrawal was rare despite a high prevalence of fentanyl.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04225598<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2025.27019","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T16:30:25Z","timestamp":1770827425000},"page":"948","source":"Crossref","is-referenced-by-count":15,"title":["Emergency Department\u2013Initiated Buprenorphine for Opioid Use Disorder"],"prefix":"10.1001","volume":"335","author":[{"given":"Gail","family":"D\u2019Onofrio","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Department of Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew A.","family":"Herring","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Division of Addiction Medicine, Highland General Hospital\u2013Alameda Health System, Oakland, California"},{"name":"Department of Emergency Medicine, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn F.","family":"Hawk","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut"},{"name":"Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanmarie","family":"Perrone","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan","family":"Cowan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P.","family":"McCormack","sequence":"additional","affiliation":[{"name":"Ronald O. 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