Academic Emergency Medicine最新文献

Study objective: To characterize opioid and nonopioid drug use in the week following emergency department (ED)-initiated extended-release buprenorphine (XR-BUP) treatment using both self-reported data and urine drug screens (UDS).

Methods: This study uses data collected during a nonrandomized clinical trial of patients with untreated opioid use disorder (OUD), testing the safety and feasibility of initiating XR-BUP in patients presenting with minimal to mild withdrawal. The study was conducted from July 2020 to May 2023 across four urban academic EDs in the Northeast, Mid-Atlantic, and Pacific regions of the United States. A total of 100 participants, 18 years or older with OUD defined by DSM-5 criteria, a clinical opiate withdrawal scale (COWS < 8), and a positive opioid urine screen were included. Individuals with recent MOUD treatment, presentation for overdose, or concurrent methadone use were excluded. All participants received a single subcutaneous injection of 24 mg XR-BUP (CAM2038) during their ED visit. The primary outcomes were self-reported daily opioid and nonopioid drug use over 7 days postinjection using daily Qualtrics surveys and UDS results on day 7.

Results: Among participants who received XR-BUP and completed daily surveys, 98% reported at least one opioid-free day, and 63% reported no opioid use across all 7 days. Day 7 UDS results showed decreased detection of opioids, stimulants, and benzodiazepines. Reported polysubstance use also declined over the observation period.

Conclusions: ED-initiated XR-BUP was associated with substantial reductions in opioid and polysubstance use during the first week post-discharge, supporting its role in early overdose risk mitigation and highlighting its value as an ED-based intervention for opioid use disorder.

Trial registration: ClinicalTrials.gov Identifier: NCT03658642.

Background: The "minority tax", also known as the "diversity tax" refers to the additional burden placed on minoritized individuals in advancing diversity, equity, and inclusion (DEI). Although DEI efforts have evolved over time, evidence on its emotional, professional, and institutional impacts in academic emergency medicine (EM) is limited. We examined the various impacts of the minority tax in this population.

Methods: We conducted a qualitative study using a descriptive phenomenological framework to explore the lived experiences of 21 academic EM faculty leaders engaged in DEI work. Participants were purposively sampled across U.S. regions. Semi-structured interviews were conducted (March-May 2023), transcribed, and analyzed using thematic analysis informed by both inductive and deductive coding strategies. We explored personal and professional impacts of DEI engagement, experiences with the minority tax, and strategies for mitigation.

Results: Participants described their DEI roles as a "double-edged sword," balancing meaningful engagement with substantial emotional and professional costs. Sixteen of 21 participants identified direct experiences with the minority tax, including expectations to serve as cultural representatives, provide uncompensated labor, and experiences of institutional marginalization. Despite these challenges, many participants found personal fulfillment in their work and emphasized mentorship as both a key source of support and a driver of career advancement. Suggested strategies for addressing the minority tax included stronger institutional support, appropriate compensation for DEI contributions, and equitable distribution of DEI responsibilities across all faculty, regardless of identity.

Conclusions: The minority tax in academic emergency medicine presents a complex challenge that carries significant emotional and professional costs even as DEI work can provide personal meaning and career advancement. Addressing this burden requires systemic changes, including recognition of DEI efforts in career progression and shared responsibility across all faculty demographics.