2025 Southeastern Residency Conference

Title: Implementation of a Pharmacist-Managed Buprenorphine Induction Protocol for Patients with Opioid Use Disorder (OUD) in the Inpatient Setting  


Authors: Madeline Lysogorski, PharmD, Charleen Melton, PharmD, BCCCP, Holly McLean PharmD, CPP, BCPS, BCCCP, Joe Norton PharmD, BCPS  
 
Background: 
In recent years, there has been an increase in research published discussing high-dose buprenorphine for induction of Medication-Assisted Therapy (MAT) in patients with Opioid Use Disorder (OUD), with the primary setting being inpatient induction. However, none of these studies specifically highlight interventions that can be made by a clinical pharmacist during the induction process. This study aims to evaluate the impact of a pharmacist-managed buprenorphine MAT- induction protocol in hospitalized patients with OUD. 
 
Methods:  
This study is being conducted as a prospective chart review at CaroMont Regional Medical Center, a 476-bed not-for-profit community hospital located in Gastonia, NC. Patients will be evaluated for withdrawal symptoms by an attending physician, who will subsequently order a pharmacy consult for patients to be initiated on buprenorphine. The patients will then be enrolled in the pharmacy protocol and followed until they are successfully maintained on their maintenance dose (Day 3 of the consult). Data will be collected utilizing the hospital’s electronic health record (EHR) and will evaluate patients that were initiated on the buprenorphine initiation protocol from November 1st, 2024, through March 31st, 2025. Those included in the study will be adult inpatients over 18 years old that are initiated on the pharmacist-managed buprenorphine protocol. Patients will be excluded if they are part of a vulnerable population (under 18 years old or incarcerated), if they are already established on a buprenorphine/naloxone regimen outpatient, or if they were initiated on buprenorphine in the emergency department (ED) and discharged to complete induction outpatient. The primary outcome to analyze in this study is the number of patients who had successful buprenorphine induction on the pharmacist-managed protocol, defined as the patient not leaving AMA, completing the induction protocol during their admission, and being successfully connected to care at discharge.  
 
Results: A total of 15 patients were enrolled in the study. 13/15 patients (86.66%) had successful induction, and met our primary endpoint . 2/15 patients left AMA prior to completion of the protocol, with the average hospital length of stay being 4.5 days. The average total daily dose of buprenorphine that patients received was 19.6mg, and the average total buprenorphine dose received during admission was 58.3mg. The majority of patients (8/15) were connected to care with a local health department that provides MAT services with a bridge prescription until they were able to be seen by a provider. 
 
Conclusions: High dose buprenorphine induction in the inpatient setting is the ideal environment, due to consistent monitoring for withdrawal management. No patients in this study failed induction due to adverse events. Addressing institutional barriers can make the protocol more successful and increase recruitment.