TABLE 1.

Identification of treatment‐eligible patients before ED BUP administration (n = 31 site protocols)

	# of site protocols	% of site protocols
a) Inclusion criteria for ED BUP administration:	31	100%
OUD determination	22	71%
Formal OUD screen using DSM‐5	7	23%
Active withdrawal	31	100%
COWS score	27	87%
Clinical diagnosis of withdrawal, optional COWS score	4	13%
Time elapsed since last opioid use:	19	61%
Methadone	16	52%
Long‐acting opioids excluding methadone	9	29%
Short‐acting opioids	9	29%
Heroin	5	16%
b) Minimum COWS score required before ED BUP initiation	30	97%
Minimum COWS score of 8	27	87%
c) Contraindications to ED BUP administration:	21	68%
Recent methadone use	16	52%
Severe medical illness including liver disease	11	35%
Altered mental status and/or intoxication	9	29%
Pain, trauma, and/or planned surgeries	6	19%
Alcohol and/or benzodiazepine withdrawal or use	5	16%
Other	9	29%
d) Other evaluations before BUP administration:
Pregnancy determination	21	68%
Other labs required or when clinically indicated	9	29%
e) Guidelines for identifying patients for ED buprenorphine	6	19%
f) Ancillary staff for ED BUP	21	68%

Number of site protocols that provided guidelines related to identification of treatment‐eligible patients: (a) inclusion criteria, (b) minimum COWS score, (c) absolute contraindications to ED BUP (“other” contraindications included, but were not limited to, naloxone induced withdrawal, BUP allergy, lack of patient willingness to initiate BUP, and exacerbation of psychiatric illness or active psychosis), (d) other evaluations (other labs included urine toxicology, liver function tests, complete blood count (CBC), basic/complete metabolic panel [BMP/CMP], and otherwise not specified), (e) guidelines to identify patients, and (f) ancillary staff.

Abbreviations: BUP, buprenorphine; COWS, Clinical Opiate Withdrawal Scale; DSM‐5, Diagnostic and Statistical Manual of Mental Disorders, 5th edition; ED, emergency department; OUD, opioid use disorder