Beginning in December 2017, the Medical University of South Carolina (MUSC) led the implementation of an emergency department-based buprenorphine initiation program in three diverse South Carolina emergency departments (ED) utilizing a predominantly peer recovery coach model. These peers serve as patient navigators that are individuals in long-term recovery and trained in motivational interviewing techniques. 

All patients admitted to the ED were screened for substance use disorder. Patient navigators were brought in when staff felt like a patient was a candidate for an intervention. Those screening positive for opioid use disorder (OUD) and eligible to receive buprenorphine were offered to be initiated in the ED. Patient navigators followed up with patients after 24 hours to encourage attendance at next-day appointments to continue buprenorphine treatment. Additionally, patients were offered an intranasal naloxone kit and education prior to discharge.

The emergency department at MUSC is currently involved in two clinical trials on OUD treatment in the ED, one on using peer recovery coaches after nonfatal overdose and another as part of a nationwide study on buprenorphine initiation in the ED. 

The program has shown promising preliminary results for cost-effectiveness and retention in treatment. 

More information can be found in these news articles here and here, and in these presentations from the co-authors of the peer-reviewed evaluation here and here.