A National Survey of Pediatric Emergency Medicine Clinicians' Comfort Level, Beliefs, and Experiences With Initiating Buprenorphine in the Emergency Department

Introduction: The prevalence of opioid use disorder (OUD) among adolescents has seen an alarming rise, prompting an exploration of the utilization of buprenorphine as a treatment modality. This study aimed to understand the perceptions, experiences, and comfort levels of pediatric emergency medicine (PEM) clinicians in initiating medication-assisted treatment (MAT) for pediatric patients presenting with OUD in emergency departments. Methods: Utilizing a cross-sectional survey design, data from 110 respondents were collected from a potential participant pool of 3062 for a response rate of 3.6%. The survey assessed demographics, clinical encounters, comfort levels, and opinions concerning the use of buprenorphine in the pediatric emergency setting. Results: Only 3.6% of respondents frequently evaluated and treated opioid withdrawal in the ED. A significant majority, 87.3%, indicated they had never prescribed buprenorphine for patients under 18 in the ED. While 53% of clinicians believed in initiating buprenorphine for adolescents with OUD in the ED, 33.6% expressed feeling "very uncomfortable" with the initiation process. Training in MAT appeared to influence attitudes and comfort levels significantly. Conclusions: In this convenience sample survey with a 3.6% response rate, we found that a pronounced discomfort exists among PEM clinicians in initiating MAT, predominantly rooted in a lack of experience. Addressing this barrier through comprehensive training, developing evidence-based protocols, and fostering interdisciplinary collaboration is imperative to ensure optimal care for adolescents with OUD in emergency settings.