Buprenorphine Initiation in the Emergency Department: a Thematic Content Analysis of a #firesidetox Tweetchat

Abstract

Introduction: The height of the opioid epidemic in the USA has led to an increasing call for access to medication assisted treatment for opioid use disorder, including buprenorphine initiation from the emergency department (ED). However, only a small percentage of emergency physicians feel prepared or have the necessary training to prescribe buprenorphine. Twitter has increasingly been used as a tool for medical education, and there is growing interest in using this forum to actively engage medical providers and the public. This study examined the views regarding ED initiation of buprenorphine treatment among contributors to the quarterly American College of Medical Toxicology (ACMT) tweetchat, #firesidetox, and the demographics of the participants. Methods: A mixed methods descriptive study was conducted to analyze individual responses and self-identified demographics among Twitter users participating in the #firesidetox tweetchat regarding the ACMT position statement about ED initiation of buprenorphine treatment. Results: This tweetchat included 86 participants, the majority of whom were clinicians in the USA. Physicians accounted for 46% of participants primarily emergency medicine physician toxicologists and authored 75% of the tweets. It consisted of 317 tweets which most frequently described clinical vignettes or experience (46%) or medical education (25%) related to buprenorphine and had themes related to treatment initiation location (ED vs outpatient vs home) (8.6%) and challenges and solutions to buprenorphine administration (8.6%). Conclusions: A tweetchat can be used to disseminate and discuss the adoption of buprenorphine in the ED. Importantly, the tweetchat provides a forum for experts to share narratives and expertise on implementation and barriers and successes in operationalizing buprenorphine administration in emergency departments.