Impact of Administering Buprenorphine to Overdose Survivors Using Emergency Medical Services.

STUDY OBJECTIVE: To evaluate the efficacy and safety of utilizing emergency medical services units to administer high dose buprenorphine after an overdose to treat withdrawal symptoms, reduce repeat overdose, and provide a next-day substances use disorder clinic appointment to initiate long-term treatment. METHODS: This was a retrospective matched cohort study of patients who experienced an overdose and either received emergency medical services care from a buprenorphine-equipped ambulance or a nonbuprenorphine-equipped ambulance in Camden, New Jersey, an urban community with high overdose rates. There were 117 cases and 123 control patients in the final sample. RESULTS: Compared with a nonbuprenorphine-equipped ambulance, exposure to a buprenorphine-equipped ambulance was associated with greater odds of engaging in opioid use disorder treatment within 30 days of an emergency medical services encounter (unadjusted odds ratio: 5.62, 95% confidence interval, 2.36 to 13.39). Buprenorphine-equipped ambulance engagement did not decrease repeat overdose compared to the comparison group. Patients who received buprenorphine experienced a decrease in withdrawal symptoms. Their clinical opiate withdrawal scale score decreased from an average of 9.27 to 3.16. buprenorphine-equipped ambulances increased on-scene time by 6.12 minutes. CONCLUSION: Patients who encountered paramedics trained to administer buprenorphine and able to arrange prompt substance use disorder treatment after an acute opioid overdose demonstrated a decrease in opioid withdrawal symptoms, an increase in outpatient addiction follow-up care, and showed no difference in repeat overdose. Patients receiving buprenorphine in the out-of-hospital setting did not experience precipitated withdrawal. Expanded out-of-hospital treatment of opiate use disorder is a promising model for rapid access to buprenorphine after an overdose in a patient population that often has limited contact with the health care system.

METHADONE INITIATION IN THE EMERGENCY DEPARTMENT FOR OPIOID USE DISORDER: A CASE SERIES.

BACKGROUND: In an era of fentanyl and continually rising rates of opioid overdose deaths, increasing access to evidence-based treatment for opioid use disorder (OUD) should be prioritized. Emergency department (ED) buprenorphine initiation for patients with OUD is considered best-practice. Methadone, though also evidence-based and effective, is under-utilized due to strict federal regulation, significant stigma, and lack of physician training. We describe the novel utilization of CFR Title 21 1306.07 (b), also known as the "72-hour rule," to initiate methadone for OUD in the ED. CASE SERIES: We describe the cases of 3 patients with a history of OUD who were initiated on methadone for OUD in the ED, linked to an opioid treatment program, and attended an intake appointment. Why Should an Emergency Physician Be Aware of This? The ED can be a crucial point of intervention for vulnerable patients with OUD who may not interact with the health care system in other settings. Methadone and buprenorphine are both first-line options for medication for OUD, and methadone may be preferred in patients who have been unsuccessful with buprenorphine in the past or those at higher risk of treatment dropout. Patients may also prefer methadone to buprenorphine based on previous experience or understanding of the medications. ED physicians may utilize the "72-hour rule" to administer and initiate methadone for up to 3 consecutive days while arranging referral to treatment. EDs can develop methadone initiation and bridge programs utilizing similar strategies to those that have been described in developing buprenorphine programs.

Optimizing Prehospital Stroke Systems of Care-Reacting to Changing Paradigms (OPUS-REACH): a pragmatic registry of large vessel occlusion stroke patients to create evidence-based stroke systems of care and eliminate disparities in access to stroke care.

BACKGROUND: Large vessel occlusion (LVO) strokes are best treated with rapid endovascular therapy (EVT). There are two routes that LVO stroke patients can take to EVT therapy when transported by EMS: primary transport (ambulance transports directly to an endovascular stroke center (ESC) or secondary transport (EMS transports to a non-ESC then transfers for EVT). There is no clear evidence which path to care results in better functional outcomes for LVO stroke patients. To find this answer, an analysis of a large, real-world population of LVO stroke patients must be performed. METHODS: A pragmatic registry of LVO stroke patients from nine health systems across the United States. The nine health systems span urban and rural populations as well as the spectrum of socioeconomic statuses. We will use univariate and multivariate analysis to explore the relationships between type of EMS transport, socioeconomic factors, and LVO stroke outcomes. We will use geographic information systems and spatial analysis to examine the complex movements of patients in time and space. To detect an 8% difference between groups, with a 3:1 patient ratio of primary to secondary transports, 95% confidence and 80% power, we will need approximately 1600 patients. The primary outcome is the patients with modified Rankin Scale (mRS) ≤ 2 at 90 days. Subgroup analyses include patients who receive intravenous thrombolysis and duration of stroke systems. Secondary analyses include socioeconomic factors associated with poor outcomes after LVO stroke. DISCUSSION: Using the data obtained from the OPUS-REACH registry, we will develop evidence based algorithms for prehospital transport of LVO stroke patients. Unlike prior research, the OPUS-REACH registry contains patient-level data spanning from EMS dispatch to ninety day functional outcomes. We expect that we will find modifiable factors and socioeconomic disparities associated with poor outcomes in LVO stroke. OPUS-REACH with its breadth of locations, detailed patient records, and multidisciplinary researchers will design the optimal prehospital stroke system of care for LVO stroke patients.

Accelerating Hydrogen Absorption and Desorption Rates in Palladium Nanocubes with an Ultrathin Surface Modification.

Exploiting the high surface-area-to-volume ratio of nanomaterials to store energy in the form of electrochemical alloys is an exceptionally promising route for achieving high-rate energy storage and delivery. Nanoscale palladium hydride is an excellent model system for understanding how nanoscale-specific properties affect the absorption and desorption of energy carrying equivalents. Hydrogen absorption and desorption in shape-controlled Pd nanostructures does not occur uniformly across the entire nanoparticle surface. Instead, hydrogen absorption and desorption proceed selectively through high-activity sites at the corners and edges. Such a mechanism hinders the hydrogen absorption rates and greatly reduces the benefit of nanoscaling the dimensions of the palladium. To solve this, we modify the surface of palladium with an ultrathin platinum shell. This modification nearly removes the barrier for hydrogen absorption (89 kJ/mol without a Pt shell and 1.8 kJ/mol with a Pt shell) and enables diffusion through the entire Pd/Pt surface.

Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series.

The opioid epidemic is currently a leading health crisis in the United States, and evidence supports Medication for Opioid Use Disorder (MOUD) as the most effective treatment (2). In our EMS system we are observing an ever increasing number of patients who, due to refusing transport after naloxone rescue, represent an access void at the point of overdose. We present a case series to illustrate a new treatment paradigm utilizing front line EMS paramedic units and high dose buprenorphine to treat withdrawal symptoms with next day bridge to long term care. The three patients described are exemplary cases, meant to represent overall characteristics of the intervention prior to complete data collection. Each patient was revived from opioid overdose with naloxone. Paramedics then treated each patient with 16 mg of buprenorphine to relieve and prevent withdrawal symptoms. Patients were provided with outpatient follow up irrespective of ED transport. To the best of our knowledge, this is the first EMS agency in the United States providing MOUD in the prehospital setting at the point of overdose. This innovative program provides EMS with education and tools to promote patient engagement. While still in its infancy, this approach utilizes existing EMS resources to bring MOUD to the prehospital setting, offering a new avenue to long term care. Keywords: Opioid, buprenorphine, emergency medical services, medication assisted therapy, naloxone, overdose.

Modulating donor-acceptor transition energies in phosphorus-boron co-doped silicon nanocrystals via X- and L-type ligands.

In this work, we explore the effect of ligand binding groups on the visible and NIR photoluminescent properties within phosphorus-boron co-doped silicon nanocrystals (PB:Si NCs) by exploiting both the X-type (covalent) and L-type (Lewis donor molecule) bonding interactions. We find that the cooperative nature of both X- and L-type bonding from alkoxide/alcohol, alkylamide/alkylamine, and alkylthiolate/alkylthiol on PB:Si NCs results in photoluminescence (PL) energy blue shifts from the as-synthesized, hydride-terminated NCs (PB:Si-H) in excess of 0.4 eV, depending on the surface termination. These PL blue shifts appear greatest in the most strongly confined samples with diameters <4 nm where the surface-to-volume ratio is high and, therefore, the ligand effects are most pronounced. A correlation between the donor group strength (either X-type or L-type) and the degree of D-A state modulation is found, and the proportion of the PL blue shift from the X- and L-type interactions is quantified. Raman spectroscopy is used to provide additional evidence of the strength of the L-type donor groups. Additionally, we probe how the nature of the ligand chemistry affects the radiative lifetime and PL efficiency and find that the ligands do not significantly change the D-A emission dynamics, and all samples retain the long 50-130 µs lifetimes characteristic of these transitions. Finally, we describe three mechanisms that operate to affect the D-A recombination energies: (1) X-type ligands that modulate the PB:Si-X NC wavefunction; (2) L-type ligands that perturb the donor and acceptor states via a molecular orbital theory picture; and (3) X- and L-type ligands that cause a dielectric increase around the PB:Si NC core, which provides Coulomb screening and modulates the donor and acceptor states even further.

Rural and Remote Cardiology During the COVID-19 Pandemic: Cardiac Society of Australia and New Zealand (CSANZ) Consensus Statement.

THE CHALLENGES: Rural and remote Australians and New Zealanders have a higher rate of adverse outcomes due to acute myocardial infarction, driven by many factors. The prevalence of cardiovascular disease (CVD) is also higher in regional and remote populations, and people with known CVD have increased morbidity and mortality from coronavirus disease 2019 (COVID-19). In addition, COVID-19 is associated with serious cardiac manifestations, potentially placing additional demand on limited regional services at a time of diminished visiting metropolitan support with restricted travel. Inter-hospital transfer is currently challenging as receiving centres enact pandemic protocols, creating potential delays, and cardiovascular resources are diverted to increasing intensive care unit (ICU) and emergency department (ED) capacity. Regional and rural centres have limited staff resources, placing cardiac services at risk in the event of staff infection or quarantine during the pandemic. MAIN RECOMMENDATIONS: Health districts, cardiologists and government agencies need to minimise impacts on the already vulnerable cardiovascular health of regional and remote Australians and New Zealanders throughout the COVID-19 pandemic. Changes in management should include.

Tuning Confinement in Colloidal Silicon Nanocrystals with Saturated Surface Ligands.

The optical properties of silicon nanocrystals (Si NCs) are a subject of intense study and continued debate. In particular, Si NC photoluminescence (PL) properties are known to depend strongly on the surface chemistry, resulting in electron-hole recombination pathways derived from the Si NC band-edge, surface-state defects, or combined NC-conjugated ligand hybrid states. In this Letter, we perform a comparison of three different saturated surface functional groups-alkyls, amides, and alkoxides-on nonthermal plasma-synthesized Si NCs. We find a systematic and size-dependent high-energy (blue) shift in the PL spectrum of Si NCs with amide and alkoxy functionalization relative to alkyl. Time-resolved photoluminescence and transient absorption spectroscopies reveal no change in the excited-state dynamics between Si NCs functionalized with alkyl, amide, or alkoxide ligands, showing for the first time that saturated ligands-not only surface-derived charge-transfer states or hybridization between NC and low-lying ligand orbitals-are responsible for tuning the Si NC optical properties. To explain these PL shifts we propose that the atom bound to the Si NC surface strongly interacts with the Si NC electronic wave function and modulates the Si NC quantum confinement. These results reveal a potentially broadly applicable correlation between the optoelectronic properties of Si NCs and related quantum-confined structures based on the interaction between NC surfaces and the ligand binding group.

Control of Energy Flow Dynamics between Tetracene Ligands and PbS Quantum Dots by Size Tuning and Ligand Coverage.

We have prepared a series of samples with the ligand 6,13-bistri(iso-propyl)silylethynyl tetracene 2-carboxylic acid (TIPS-Tc-COOH) attached to PbS quantum dot (QD) samples of three different sizes in order to monitor and control the extent and time scales of energy flow after photoexcitation. Fast energy transfer (∼1 ps) to the PbS QD occurs upon direct excitation of the ligand for all samples. The largest size QD maintains the microsecond exciton lifetime characteristic of the as-prepared oleate terminated PbS QDs. However, two smaller QD sizes with lowest exciton energies similar to or larger than the TIPS-Tc-COO- triplet energy undergo energy transfer between QD core and ligand triplet on nanosecond to microsecond timescales. For the intermediate size QDs in particular, energy can be recycled many times between ligand and core, but the triplet remains the dominant excited species at long times, living for ∼3 µs for fully exchanged QDs and up to 30 µs for partial ligand exchange, which is revealed as a method for controlling the triplet lifetime. A unique upconverted luminescence spectrum is observed that results from annihilation of triplets after exclusive excitation of the QD core.

n-Type PbSe Quantum Dots via Post-Synthetic Indium Doping.

We developed a postsynthetic treatment to produce impurity n-type doped PbSe QDs with In3+ as the substitutional dopant. Increasing the incorporated In content is accompanied by a gradual bleaching of the interband first-exciton transition and concurrently the appearance of a size-dependent, intraband absorption, suggesting the controlled introduction of delocalized electrons into the QD band edge states under equilibrium conditions. We compare the optical properties of our In-doped PbSe QDs to cobaltocene treated QDs, where the n-type dopant arises from remote reduction of the PbSe QDs and observe similar behavior. Spectroelectrochemical measurements also demonstrate characteristic n-type signatures, including both an induced absorption within the electrochemical bandgap and a shift of the Fermi-level toward the conduction band. Finally, we demonstrate that the In3+ dopants can be reversibly removed from the PbSe QDs, whereupon the first exciton bleach is recovered. Our results demonstrate that PbSe QDs can be controllably n-type doped via impurity aliovalent substitutional doping.

Acute bilateral retinal artery occlusion causing sudden blindness in 25-year-old patient.

A 25-year-old male patient presented to the emergency department with the chief complaint of sudden blindness and was found to have suffered bilateral central retinal artery occlusion (CRAO). This process is most commonly the result of a thrombus or embolus that occludes the retinal artery, and normally presents in a single eye in patients older than 65 who are predisposed to vascular disease. Diagnosis relies most heavily upon funduscopic exam. Potential treatments involve ocular massage, acetazolamide, anterior chamber paracentesis and systemic or local fibrinolysis. Despite these interventions vision is often significantly and permanently impaired. This case underscores the importance of the emergency physician's ability to promptly perform and interpret the funduscopic exam in order to diagnose and evaluate CRAO.

Potentiometric Measurements of Semiconductor Nanocrystal Redox Potentials.

A potentiometric method for measuring redox potentials of colloidal semiconductor nanocrystals (NCs) is described. Fermi levels of colloidal ZnO NCs are measured in situ during photodoping, allowing correlation of NC redox potentials and reduction levels. Excellent agreement is found between electrochemical and optical redox-indicator methods. Potentiometry is also reported for colloidal CdSe NCs, which show more negative conduction-band-edge potentials than in ZnO. This difference is highlighted by spontaneous electron transfer from reduced CdSe NCs to ZnO NCs in solution, with potentiometry providing a measure of the inter-NC electron-transfer driving force. Future applications of NC potentiometry are briefly discussed.

Electronic doping and redox-potential tuning in colloidal semiconductor nanocrystals.

Electronic doping is one of the most important experimental capabilities in all of semiconductor research and technology. Through electronic doping, insulating materials can be made conductive, opening doors to the formation of p-n junctions and other workhorses of modern semiconductor electronics. Recent interest in exploiting the unique physical and photophysical properties of colloidal semiconductor nanocrystals for revolutionary new device technologies has stimulated efforts to prepare electronically doped colloidal semiconductor nanocrystals with the same control as available in the corresponding bulk materials. Despite the impact that success in this endeavor would have, the development of general and reliable methods for electronic doping of colloidal semiconductor nanocrystals remains a long-standing challenge. In this Account, we review recent progress in the development and characterization of electronically doped colloidal semiconductor nanocrystals. Several successful methods for introducing excess band-like charge carriers are illustrated and discussed, including photodoping, outer-sphere electron transfer, defect doping, and electrochemical oxidation or reduction. A distinction is made between methods that yield excess band-like carriers at thermal equilibrium and those that inject excess charge carriers under thermal nonequilibrium conditions (steady state). Spectroscopic signatures of such excess carriers, accessible by both equilibrium and nonequilibrium methods, are reviewed and illustrated. A distinction is also proposed between the phenomena of electronic doping and redox-potential shifting. Electronically doped semiconductor nanocrystals possess excess band-like charge carriers at thermal equilibrium, whereas redox-potential shifting affects the potentials at which charge carriers are injected under nonequilibrium conditions, without necessarily introducing band-like charge carriers at equilibrium. Detection of the key spectroscopic signatures of band-like carriers allows distinction between these two regimes. Both electronic doping and redox-potential shifting can be powerful tools for tuning the performance of nanocrystals in electronic devices. Finally, key chemical challenges associated with nanocrystal electronic doping are briefly discussed. These challenges are centered largely on the availability of charge-carrier reservoirs with suitable redox potentials and on the relatively poor control over nanocrystal surface traps. In most cases, the Fermi levels of colloidal nanocrystals are defined by the redox properties of their surface traps. Control over nanocrystal surface chemistries is therefore essential to the development of general and reliable strategies for electronically doping colloidal semiconductor nanocrystals. Overall, recent progress in this area portends exciting future advances in controlling nanocrystal compositions, surface chemistries, redox potentials, and charge states to yield new classes of electronic nanomaterials with attractive physical properties and the potential to stimulate unprecedented new semiconductor technologies.

Limb-threatening Deep Venous Thrombosis Complicating Warfarin Reversal with Three-factor Prothrombin Complex Concentrate: A Case Report.

BACKGROUND: Three- and four-factor prothrombin complex concentrates (PCC) are gaining popularity for acute reversal of vitamin K antagonist-associated bleeding. Although acute thrombosis after PCC administration has been described, it seems to be rare. CASE REPORT: An 83-year-old woman on warfarin for history of deep venous thrombosis (DVT) presented to the Emergency Department with life-threatening gastrointestinal bleeding, requiring urgent PCC administration. After stabilization, she subsequently developed a new limb-threatening upper-extremity DVT. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As PCC therapy gains popularity for reversal of anticoagulant-induced bleeding in urgent bleeding scenarios, the emergency physician must be aware of the complications of PCC administration, including new limb-threatening DVT.

Redox Potentials of Colloidal n-Type ZnO Nanocrystals: Effects of Confinement, Electron Density, and Fermi-Level Pinning by Aldehyde Hydrogenation.

Electronically doped colloidal semiconductor nanocrystals offer valuable opportunities to probe the new physical and chemical properties imparted by their excess charge carriers. Photodoping is a powerful approach to introducing and controlling free carrier densities within free-standing colloidal semiconductor nanocrystals. Photoreduced (n-type) colloidal ZnO nanocrystals possessing delocalized conduction-band (CB) electrons can be formed by photochemical oxidation of EtOH. Previous studies of this chemistry have demonstrated photochemical electron accumulation, in some cases reaching as many as >100 electrons per ZnO nanocrystal, but in every case examined to date this chemistry maximizes at a well-defined average electron density of ⟨Nmax⟩ ≈ (1.4 ± 0.4) × 10(20) cm(-3). The origins of this maximum have never been identified. Here, we use a solvated redox indicator for in situ determination of reduced ZnO nanocrystal redox potentials. The Fermi levels of various photodoped ZnO nanocrystals possessing on average just one excess CB electron show quantum-confinement effects, as expected, but are >600 meV lower than those of the same ZnO nanocrystals reduced chemically using Cp*2Co, reflecting important differences between their charge-compensating cations. Upon photochemical electron accumulation, the Fermi levels become independent of nanocrystal volume at ⟨N⟩ above ∼2 × 10(19) cm(-3), and maximize at ⟨Nmax⟩ ≈ (1.6 ± 0.3) × 10(20) cm(-3). This maximum is proposed to arise from Fermi-level pinning by the two-electron/two-proton hydrogenation of acetaldehyde, which reverses the EtOH photooxidation reaction.

Adverse Effects After Prehospital Administration of Naloxone by Bystanders: A Preliminary Study.

OBJECTIVE: Opioid use disorder is a cause of significant morbidity and mortality. In order to reverse opioid overdose as quickly as possible, many institutions and municipalities have encouraged people with no professional medical training to carry and administer naloxone. This study sought to provide preliminary data for research into the rates of adverse effects of naloxone when administered by bystanders compared to Emergency Medical Services (EMS) personnel, since this question has not been studied previously. METHODS: This was a retrospective cohort study performed at an urban, tertiary, academic medical center that operates its own EMS service. A consecutive sample of patients presenting to EMS with opioid overdose requiring naloxone was separated into two groups based on whether naloxone was administered by bystanders or by EMS personnel. Each group was analyzed to determine the incidence of four pre-specified adverse events. RESULTS: There was no significant difference in the rate of adverse events between the bystander (19%) and EMS (16%) groups (OR = 1.23; 95% CI, 0.63 - 2.32; P = .499) in this small sample. Based on these initial results, a study would need a sample size of 6,188 in order to reach this conclusion with 80% power. Similarly, there were no significant differences in the rates of any of the individual adverse events. Secondary analysis of patients' demographics showed differences between the two groups which generate hypotheses for further investigation of disparities in naloxone administration. CONCLUSIONS: This preliminary study provides foundational data for further investigation of naloxone administration by bystanders. Adverse events after the prehospital administration of naloxone are rare, and future studies will require large sample sizes. These preliminary data did not demonstrate a statistically significant difference in adverse event rates when comparing naloxone administration by bystanders and EMS clinicians. This study provides data that will be useful for conducting further research on multiple facets of this topic.

Boron-Silicon Alloy Nanoparticles as a Promising New Material in Lithium-Ion Battery Anodes.

Silicon's potential as a lithium-ion battery (LIB) anode is hindered by the reactivity of the lithium silicide (Li x Si) interface. This study introduces an innovative approach by alloying silicon with boron, creating boron/silicon (BSi) nanoparticles synthesized via plasma-enhanced chemical vapor deposition. These nanoparticles exhibit altered electronic structures as evidenced by optical, structural, and chemical analysis. Integrated into LIB anodes, BSi demonstrates outstanding cycle stability, surpassing 1000 lithiation and delithiation cycles with minimal capacity fade or impedance growth. Detailed electrochemical and microscopic characterization reveal very little SEI growth through 1000 cycles, which suggests that electrolyte degradation is virtually nonexistent. This unconventional strategy offers a promising avenue for high-performance LIB anodes with the potential for rapid scale-up, marking a significant advancement in silicon anode technology.

Hospital-initiated Extended-release Injectable Buprenorphine Using a Novel Reallocation Initiative From an Outpatient Addiction Medicine Clinic.

OBJECTIVES: Novel strategies for initiation and continuation of buprenorphine are critical, especially during a pandemic when traditional opioid use disorder treatment pathways may be disrupted. We describe an innovative outpatient to inpatient reallocation initiative for extended-release buprenorphine (XR-BUP) designed to repurpose an expensive medication for use in hospitalized patients facing treatment barriers upon discharge and pilot the feasibility of XR-BUP use in the inpatient setting. METHODS: We collaborated with our institution's inpatient pharmacy and a New Jersey Medicaid managed care organization to create an alternate pathway to make XR-BUP available to hospitalized patients insured by the same payor. In this process, XR-BUP doses were deidentified and transferred to the inpatient controlled substance inventory for administration to hospitalized patients at no charge by our Addiction Medicine Consult Service after a period of sublingual buprenorphine stabilization. Our reallocation pathway bypassed several existing XR-BUP regulatory barriers to allow for inpatient administration. RESULTS: To date, we have transferred approximately 85 XR-BUP 300 mg doses to the inpatient controlled substance inventory. This equates to a cost savings of nearly $145,000. CONCLUSIONS: Reallocation of XR-BUP from an outpatient to inpatient setting increased postdischarge buprenorphine treatment access while also reducing health care costs by repurposing an expensive medication that would otherwise go to waste. Use of reallocated XR-BUP in the inpatient setting may pave the way for addition of XR-BUP to the hospital's formulary to minimize treatment gaps after discharge.

Attitudes on Methadone Utilization in the Emergency Department: A Physician Cross-sectional Study.

INTRODUCTION: Like buprenorphine, methadone is a life-saving medication that can be initiated in the emergency department (ED) to treat patients with an opioid use disorder (OUD). The purpose of this study was to better understand the attitudes of emergency physicians (EP) on offering methadone compared to buprenorphine to patients with OUD in the ED. METHODS: We distributed a perception survey to emergency physicians through a national professional network. RESULTS: In this study, the response rate was 18.4% (N = 141), with nearly 70% of the EPs having ordered either buprenorphine or methadone. 75% of EPs strongly or somewhat agreed that buprenorphine was an appropriate treatment for opioid withdrawal and craving, while only 28% agreed that methadone was an appropriate treatment. The perceived barriers to using buprenorphine and methadone in the ED were similar. CONCLUSION: It is essential to create interventions for EPs to overcome stigma and barriers to methadone initiation in the ED for patients with opioid use disorder. Doing so will offer additional opportunities and pathways for initiation of multiple effective medications for OUD in the ED. Subsequent outpatient treatment linkage may lead to improved treatment retention and decreased morbidity and mortality from ongoing use.