A clinical trial led by UC Davis Health is investigating the potential of telehealth to enhance long-term adherence to buprenorphine, a crucial medication for treating opioid use disorder (OUD). The study focuses on patients initiating buprenorphine treatment in emergency departments, where consistent follow-up care is essential. With opioid addiction remaining a significant public health crisis, this research aims to identify strategies for keeping individuals engaged in care and preventing overdose deaths.
Addressing the Opioid Crisis with Buprenorphine
Opioid addiction continues to claim approximately 9,000 lives each month in the U.S., with three-quarters of these deaths involving opioids. Buprenorphine has demonstrated effectiveness in reducing overdose risk, but many patients discontinue its use within six months. "Most people with OUD require buprenorphine for years to effectively manage their condition," said Stephen Henry, co-principal investigator and associate professor of internal medicine at UC Davis Health. "This study aims to identify how we can keep these individuals engaged in care over the long term to prevent overdose deaths and support recovery."
Telehealth vs. In-Person Care: A $6.4 Million Study
The $6.4 million study, funded by the Patient-Centered Outcomes Research Institute (PCORI), will compare the effectiveness of telehealth (video or phone visits) with traditional in-person follow-up appointments. The study is designed to overcome common barriers faced by patients, such as low income, lack of transportation, and social instability. Aimee Moulin, professor of emergency medicine and psychiatry and behavioral sciences, and co-principal investigator of the study, noted, "Patients struggling with OUD often experience social chaos, making it difficult for them to attend traditional outpatient appointments. Telehealth could offer a more accessible and less stigmatizing option for follow-up care."
Study Design and Implementation
The study will be conducted in three emergency departments participating in California’s “CA Bridge” program, which promotes substance use treatment in emergency settings. Patients starting buprenorphine treatment in the emergency department will be randomly assigned to receive follow-up care either via telehealth or in person at outpatient clinics. Researchers will compare treatment outcomes to determine if telehealth referrals lead to higher rates of outpatient treatment engagement, long-term buprenorphine retention, and overall patient satisfaction. The study will also assess the impact of patient choice in determining their follow-up care.
Implications for Vulnerable Populations
This research seeks to address disparities in OUD treatment, as patients accessing care in emergency departments are often low-income, non-white, and unstably housed. "This population is traditionally invisible or excluded from research studies," Henry stated. "Our hope is to reach the most vulnerable patients who have the highest risk of overdose death."
The study's findings have the potential to inform clinical practices in California and the nearly 20 other states implementing similar emergency department-based OUD treatment programs. The researchers aim to provide emergency physicians with guidance on the optimal referral pathways for patients with opioid use disorder, maximizing their chances of staying in treatment and recovery.
Moulin explained the importance of buprenorphine, stating, "Buprenorphine stays in the system for some time. It blocks the activity of opioid medications, like fentanyl, so that patients are less susceptible to losing consciousness and stopping breathing. For patients with opioid addiction, this medication is a lifesaver."
This study, administered by the UC Davis Center for Healthcare Policy and Research, builds on previous collaborations and pilot data from Henry and Moulin. The ultimate goal is to enhance retention strategies for buprenorphine, leading to improved recovery outcomes and a reduction in overdose fatalities.
