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Implementation of buprenorphine initiation and warm handoff protocols in emergency departments: A qualitative study of Pennsylvania hospitals

Emergency departments are a critical touchpoint for patients with opioid use disorder. In 2019, Pennsylvania had the fifth highest drug overdose mortality rate in the United States. Efforts in Pennsylvania have focused on implementing evidence-based care protocols in emergency departments, including induction of buprenorphine and warm handoffs to community treatment. This study examined the perspectives of staff in six hospitals on the processes, challenges, and facilitators to buprenorphine initiation and warm handoff protocols in emergency departments, with the aim of yielding results that can be used to optimize implementation efforts.