Embedding Equity, Transparency, and Impact Through Patient and Public Involvement: Insights From the HANDCLAP Study.

The opioid epidemic remains a public health crisis, resulting in 81,083 opioid-related overdose deaths in 2023 in the United States. Buprenorphine, a partial mu-receptor opioid agonist, has been approved as treatment for opioid use disorder (OUD) since 2002; however, it is underused in the United States, with only 25% of adults with OUD receiving this effective medication., Emergency departments (ED) continue to be a crucial interface for establishing access to care and decreasing mortality., Thus, training emergency medicine (EM) residents to treat OUD should be considered critical in improving low-barrier access to evidence-based substance use care. The Accreditation Council for Graduate Medical Education requires all graduate medical education programs to incorporate addiction training into their curricula. Residency programs that have incorporated addiction training have shown tremendous success in improving knowledge and reducing the stigma of OUD treatment. In one study, 79% of internal medicine residents felt more prepared to treat patients with OUD following didactic training. Yet a substance use disorder (SUD) curriculum, specifically one focused on OUD education and training, has not been standardized or incorporated into EM resident education nationally. In 2016, our institution began initiating and prescribing buprenorphine in the ED. Subsequently, in 2017 a SUD curriculum was formalized for both faculty and residents. Interested residents from our institution, along with emergency physicians, contributed to the curriculum development. We successfully implemented an 8-hour SUD curriculum and X-waiver training for residents starting in 2018. The X-waiver training focused on OUD treatment, which was required for physicians to prescribe buprenorphine. The curriculum also featured formal SUD lectures, clinical exposure at an addiction-medicine specialty clinic, and a pre- and post-curriculum assessment. Before 2018, residents received SUD training solely through clinical experience and a limited lecture series. Although the X-waiver regulatory program itself no longer exists, our EM residency’s SUD curriculum and OUD training remain relevant for meeting current training requirements and facilitating buprenorphine prescribing.