A Scoping Review and Consensus Recommendations for Emergency Medical Services Buprenorphine (EMS-Bupe) Programs

Abstract

Objectives: Emergency Medical Services (EMS) agencies are beginning to provide low-barrier access to treatment for opioid use disorder (OUD) through the development of EMS buprenorphine (EMS-Bupe) programs. However, evidence-based practices for these programs are lacking. Our aim was to review the current literature on EMS and emergency department (ED) based buprenorphine treatment programs to provide consensus recommendations on the EMS-Bupe program development.

Methods: We performed a scoping review of EMS-Bupe programs and ED medication for OUD (MOUD) programs. We searched Ovid MEDLINE(R), Embase.com, Cochrane Central Register of Controlled Trials and Web of Science (Science Citation Index) for English language articles and abstracts. Additional articles/abstracts as identified independently by coauthors were added. Recommendations were generated through consensus based on the findings of the scoping review and other relevant literature.

Results: We identified a total of 9 EMS-Bupe articles/abstracts and 21 ED MOUD abstract, representing 5 EMS-Bupe programs in 4 states. There was significant variability between programs, from infrastructure, medication dosing, and retention rates. Results and recommendations were grouped into 8 categories: EMS program infrastructure, withdrawal classification thresholds, EMS protocol inclusion/exclusion criteria, buprenorphine dosing and adjunct medications, EMS disposition and scene times, EMS clinician training, referrals, and EMS data collection and quality management.

Conclusions: The EMS-Bupe program data are limited but show important variability. In general, we recommend that programs respond to community needs by establishing relationships with local resources. We also favor protocols that increase patient eligibility and treatment retention. Lastly, programs should consider low-barrier, patient-centered strategies aimed at preventing gaps in treatment.