{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:25:26Z","timestamp":1766067926850,"version":"3.37.3"},"reference-count":12,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["154893"],"award-info":[{"award-number":["154893"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To identify individual and site-related factors associated with frequent emergency department (ED) buprenorphine\/naloxone (BUP) initiation. BUP initiation, an effective opioid use disorder (OUD) intervention, varies widely across Canadian EDs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We surveyed emergency physicians in 6 Canadian provinces from 2018 to 2019 using bilingual paper and web-based questionnaires. Survey domains included BUP-related practice, demographics, attitudes toward BUP, and site characteristics. We defined frequent BUP initiation (the primary outcome) as at least once per month, high OUD prevalence as at least one OUD patient per shift, and high OUD resources as at least 3 out of the following 5 resources: BUP initiation pathways, BUP in ED, peer navigators, accessible addiction specialists, and accessible follow-up clinics. We excluded responses from sites with &lt;50% participation (to minimize non-responder bias) and those missing the primary outcome. We used univariate analysis to identify associations between frequent BUP initiation and factors of interest, stratifying by OUD prevalence.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We excluded 3 responses for missing BUP initiation frequency and 9 for low response rate at one ED. Of the remaining 649 respondents from 34 EDs, 374 (58%) practiced in metropolitan areas, 384 (59%) reported high OUD prevalence, 312 (48%) had high OUD resources, and 161 (25%) initiated BUP frequently. Age, gender, board certification and years in practice were not associated with frequent BUP initiation. Site-specific factors were associated with frequent BUP initiation (high OUD resources [OR 6.91], high OUD prevalence [OR 4.45], and metropolitan location [OR 2.39],) as were individual attitudinal factors (willingness, confidence, and responsibility to initiate BUP.) Similar associations persisted in the high OUD prevalence subgroup.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Individual attitudinal and site-specific factors were associated with frequent BUP initiation. Training to increase physician confidence and increasing OUD resources could increase BUP initiation and benefit ED patients with OUD.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0297084","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T18:33:01Z","timestamp":1707157981000},"page":"e0297084","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors associated with frequent buprenorphine \/ naloxone initiation in a national survey of Canadian emergency physicians"],"prefix":"10.1371","volume":"19","author":[{"given":"Nathalie","family":"MacKinnon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8600-8895","authenticated-orcid":true,"given":"Daniel","family":"Lane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Scheuermeyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janusz","family":"Kaczorowski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1111-8720","authenticated-orcid":true,"given":"Aaron M.","family":"Orkin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raoul","family":"Daoust","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Moe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary","family":"Andolfatto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Klaiman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Yan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin J.","family":"Koh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Crowder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Atkinson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Savage","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Stempien","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Floyd","family":"Besserer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Wale","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9358-0272","authenticated-orcid":true,"given":"Andrew","family":"Kestler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,2,5]]},"reference":[{"volume-title":"Opioid- and stimulant-related harms in Canada","year":"2022","author":"Public Health Agency of Canada","key":"pone.0297084.ref001"},{"key":"pone.0297084.ref002","doi-asserted-by":"crossref","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":"T Santo","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"pone.0297084.ref003","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1111\/add.15087","article-title":"Global opioid agonist treatment: a review of clinical practices by country","volume":"115","author":"H Jin","year":"2020","journal-title":"Addiction"},{"key":"pone.0297084.ref004","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1111\/acem.14054","article-title":"Emergency department\u2013initiated interventions for patients with opioid use disorder: a systematic review","volume":"27","author":"J Kaczorowski","year":"2020","journal-title":"Acad Emerg Med"},{"key":"pone.0297084.ref005","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1017\/cem.2020.459","article-title":"CAEP position statement: emergency department management of people with opioid use disorder","volume":"22","author":"JJ Koh","year":"2020","journal-title":"CJEM"},{"key":"pone.0297084.ref006","doi-asserted-by":"crossref","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":"G D\u2019Onofrio","year":"2015","journal-title":"JAMA"},{"key":"pone.0297084.ref007","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1017\/cem.2020.438","article-title":"Multi-site intervention to improve emergency department care for patients who live with opioid use disorder: A quantitative evaluation","volume":"22","author":"P McLane","year":"2020","journal-title":"CJEM"},{"issue":"3","key":"pone.0297084.ref008","doi-asserted-by":"crossref","first-page":"E864","DOI":"10.9778\/cmajo.20200190","article-title":"Buprenorphine\u2013naloxone practice and attitudes in 22 Canadian emergency physician groups: a cross-sectional survey","volume":"9","author":"A Kestler","year":"2021","journal-title":"CMAJ Open"},{"key":"pone.0297084.ref009","doi-asserted-by":"crossref","first-page":"261","DOI":"10.5811\/westjem.2019.11.44382","article-title":"Emergency department clinician\u2019s attitudes towards opioid use disorder and emergency department-initiated buprenorphine treatment: a mixed-methods study","volume":"21","author":"DD Im","year":"2020","journal-title":"West J Emerg Med"},{"issue":"5","key":"pone.0297084.ref010","doi-asserted-by":"crossref","first-page":"e204561","DOI":"10.1001\/jamanetworkopen.2020.4561","article-title":"Barriers and facilitators to clinician readiness to provide emergency department\u2013initiated buprenorphine","volume":"3","author":"KF Hawk","year":"2020","journal-title":"JAMA Netw Open"},{"key":"pone.0297084.ref011","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/acem.14369","article-title":"This is part of emergency medicine now\u201d a qualitative assessment of emergency clinicians\u2019 facilitators of and barriers to initiating buprenorphine","volume":"29","author":"EM Schoenfeld","year":"2022","journal-title":"Acad Emerg Med"},{"key":"pone.0297084.ref012","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/acem.14002","article-title":"Interrupted time series of user-centered clinical decision support implementation for emergency department-initiated buprenorphine for opioid use disorder","volume":"27","author":"WC Holland","year":"2020","journal-title":"Acad Emerg Med"}],"container-title":["PLOS 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