Emergency Department-Initiated Buprenorphine Validation Network Trial

RCT Component:

Inclusion Criteria:

1. Be 18 years or older

2. Treated in the ED during study screening hours

3. Meet DSM-5 (Diagnostic and Statistical Manual) diagnostic criteria for moderate tosevere OUD

4. Have a COWS score of > or equal to 4

5. Have a urine toxicology test that is positive for opioids (opiates, oxycodone,buprenorphine). Patients with urines that are only positive for fentanyl will beeligible if their clinical history and physical exam are consistent with opioid useand they meet DSM-5 criteria for moderate to severe OUD.

6. Able to speak English sufficiently to understand the study the study procedures andprovide written informed consent to participate in the study. (Exception may be madeif sites with large population of Spanish speaking patients are accepted forparticipation in the study and study materials are translated into Spanish.Translated study materials will be reviewed and approved by the Institutional ReviewBoard) IRB of record prior to use.)

Exclusion Criteria:

1. Have urine toxicology test that is positive for methadone

2. Be pregnant as determined by human chorionic gonadotropin (hCG) testing at the indexED visit

3. Have a medical or psychiatric condition that requires hospitalization

4. Opioid administration (excluding BUP) at the index ED visit, prior to enrollment,and COWS remains < 8 during ED stay

5. Be actively suicidal or severely cognitively impaired precluding informed consent

6. Present from an extended care facility (e.g., skilled nursing facility)

7. Require continued prescription opioids for a pain condition

8. Be a prisoner or in police custody at the time of index ED visit

9. Be currently (anytime within the past 14 days) enrolled in formal addictiontreatment, including by court order. Patients enrolled in formal addiction who arenot receiving MOUD are eligible

10. Be unable to provide reliable locator information including 2 contact numbers inaddition to their own

11. Be unwilling to follow study procedures (e.g., unwilling to provide permission tocontact referral provider/program or unavailable for the follow-up assessments)

12. Have prior enrollment in the current study component

Ancillary Component:

Inclusion Criteria:

1. Be 18 years or older

2. Treated in the ED during study screening hours

3. Meet DSM-5 diagnostic criteria for moderate to severe opioid use disorder

4. Have a COWS <8

5. Have a urine toxicology test that is positive for opioids (opiates, oxycodone, orbuprenorphine). Patients with urines that are only positive for fentanyl on thepoint of care test strip will be eligible if their clinical history and physicalexam are consistent with opioid use and they meet DSM-5 criteria for moderate tosevere OUD.

6. Be able to speak English sufficiently to understand the study procedures and providewritten informed consent to participate in the study

Exclusion Criteria:

1. Have a urine toxicology test that is positive for methadone

2. Be pregnant as determined by human chorionic gonadotropin (hCG) testing at the indexED visit

3. Have a medical or psychiatric condition that requires hospitalization at the indexED visit, prior to enrollment

4. Be actively suicidal or severely cognitively impaired precluding informed consent

5. Present from an extended care facility (e.g., skilled nursing facility)

6. Require continued prescription opioids for a pain condition

7. Be a prisoner or in police custody at the time of index ED visit

8. Be currently (anytime within the past 7 days) enrolled in formal addictiontreatment, including by court order. Patients enrolled in formal addiction treatmentbut are not receiving MOUD are eligible

9. Be unable to provide reliable locator information including 2 contact numbers inaddition to their own

10. Be unwilling to follow study procedures (e.g., unwilling to provide permission toanswer daily assessments until day 7)

11. Have prior enrollment in the current study