201 - Curbing the Opioid Epidemic: Development and Pilot Implementation of an Inpatient Buprenorphine Induction Intervention for Adolescents

Poster Number: 201
Publication Number: 201.400

Lee A. Trope, Santa Clara Valley Medical Center, San Francisco, CA, United States; Tammy Devincentis, SCVMC, San jose, CA, United States; Lindsey H. Stagnaro, Lindsey Stagnaro, SANTA CRUZ, CA, United States; Gloria Tovar, Santa Clara Valley Medical Center, San Jose, CA, United States; Jayme Congdon, University of California, San Francisco, San Francisco, CA, United States; Monica Stemmle, Santa Clara Valley Medical Center/ Stanford, San jose, CA, United States

Background: Rates of opioid use disorder (OUD) and overdose deaths in adolescents have risen dramatically over the last decade. Though medication-assisted treatment (MAT) with buprenorphine has been shown to lower illicit drug use and prevent overdoses, only 8.5% of adolescents with OUD have access to addiction treatment, in part due to logistical barriers to buprenorphine induction in emergency department and outpatient settings. Inpatient buprenorphine induction is a potential opportunity to improve MAT access for adolescents.

Objective: To develop and implement a protocol for inpatient buprenorphine induction and discharge referrals for adolescents with OUD.

Design/Methods: We developed a pediatric protocol for inpatient buprenorphine induction and outpatient follow-up within a county health system through a collaborative process including pediatric and addiction medicine providers and staff (Figure). Adolescents < 21 years presenting to county therapists, outpatient providers, juvenile hall or emergency departments with OUD were offered admission for buprenorphine induction. Interventions included: (1) pediatric nurse training in withdrawal scoring and buprenorphine administration; (2) pediatric hospitalist and resident training in OUD epidemiology, clinical management, and buprenorphine pharmacology; and (3) closed-loop referral and warm handoff to outpatient therapy or residential facility and addiction medicine. Process outcomes were: rates of successful induction and follow-up with outpatient MAT providers. Clinical outcomes measured at 2 weeks post-discharge were: rates of treatment adherence, relapse, and overdose.

Results: During May-Dec 2021, we admitted 17 patients, for a total of 20 buprenorphine induction encounters, including 3 readmissions (Table). Eighteen (90%) inductions were successfully completed, and patients connected to outpatient MAT care after 65% of admissions. At 2-week follow-up, 11 (55%) patients had adhered to treatment, 7 (35%) relapsed, and 2 (10%) were lost to follow-up. All 3 readmitted patients had adhered to treatment at follow-up after their most recent admission. No overdoses occurred during the study period. Conclusion(s): Implementation of adolescent buprenorphine induction in the inpatient setting was feasible and could expand MAT services for adolescents with OUD. Longitudinal studies with larger samples are needed to assess long-term clinical OUD outcomes after inpatient buprenorphine induction and to determine best practices for improving access to and delivery of medication-assisted OUD treatment for adolescents.
Table. Characteristics of Participants in a Pediatric Inpatient Buprenorphine Induction Program (Nf17)
Figure. Buprenorphine Induction Workflow for Inpatient Pediatric UnitFigure_BupPASAbstract.JPEG