Development and Evaluation of a Post-Emergency Department Buprenorphine Initiation Support Intervention

About This Grant

Project Summary/Abstract This K23 award will enable Dr. Shastry (principal investigator, PI) to become an independent physician- scientist focused on improving emergency department (ED) care for patients with opioid use disorder (OUD) through the development and evaluation of behavioral and clinical interventions. Opioid overdose deaths continue to exert a significant mortality burden, with over 50,000 deaths in the United States in 2024. Buprenorphine (BUP), a medication for opioid use disorder (OUD), has been shown to decrease opioid overdose mortality and morbidity and can be initiated in the ED. However, BUP adherence and treatment retention is challenging, with high rates of patient attrition, particularly in the first month after ED BUP initiation. The first month after ED BUP initiation is also a uniquely high-risk time with regard to recurrent overdose and mortality. Therefore, there is an essential need to understand barriers to BUP adherence in the first month after ED BUP initiation, and to develop and test behavioral and clinical interventions to address these barriers. During this K23, Dr. Shastry (PI) will: (1) characterize barriers to ED BUP adherence and treatment retention in the first month following ED BUP initiation using mixed-methods; (2) develop and refine a targeted multi- component behavioral and clinical intervention aimed at supporting patients in the first month after ED BUP initiation; and (3) evaluate feasibility, acceptability and preliminary efficacy of this post-ED BUP initiation support intervention through a pilot randomized controlled trial (RCT). To achieve the Specific Aims of her K23 research project, Dr. Shastry (PI) has prepared a research and career development training plan comprised of rigorous mentorship and didactic coursework in mixed-methods research, intervention development and clinical trials. She also has assembled a nationally recognized mentorship team with extensive and renowned content expertise in these areas. Her proposed research and career development plan will enable Dr. Shastry’s (PI) transition to an independent physician-scientist focused on improving ED OUD care through behavioral and clinical interventions. Completion of her K23 research project will provide Dr. Shastry (PI) with crucial preliminary data to estimate the effect size of the novel post-ED BUP initiation support intervention’s efficacy on increasing treatment retention and reducing overdose, informing her subsequent large multi-site R01 RCT evaluating the efficacy of this intervention.