embed_buprenorphine_initiation: EMBED Buprenorphine Initiation Decision Support

In cliot: Clinical Indices and Outcomes Tools

EMBED Buprenorphine Initiation Decision Support

Description

Provides clinical decision support for initiating buprenorphine in the Emergency Department for patients with Opioid Use Disorder (OUD). The algorithm evaluates OUD diagnosis, treatment readiness, withdrawal severity (COWS score), pregnancy status, and provider waiver status to recommend appropriate actions (initiation, home induction, or referral).

Usage

embed_buprenorphine_initiation(oud_present, treatment_readiness,
                               withdrawal_severity_cows, pregnant, waiver_status)

Arguments

oud_present	Numeric (0 or 1). Does the patient meet DSM-5 criteria for Opioid Use Disorder? (1 = Yes).
treatment_readiness	Numeric (0 or 1). Is the patient ready to start treatment today? (1 = Yes).
withdrawal_severity_cows	Numeric. The patient's Clinical Opiate Withdrawal Scale (COWS) score.
pregnant	Numeric (0 or 1). Is the patient pregnant? (1 = Yes).
waiver_status	Numeric (0 or 1). Does the provider have a waiver (X-waiver) to prescribe buprenorphine? (1 = Yes). Note: Recent US legislation removed the X-waiver requirement, but local protocols may vary.

Value

A list containing:

Recommendation

Clinical guidance on whether to initiate, observe, or refer.

References

Melnick ER, et al. User-centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial. BMJ. 2022;377:e069271.

Examples

# Example 1: Ready for Induction
# OUD Yes, Ready Yes, COWS 10 (Moderate), Not Pregnant, Waiver Yes
embed_buprenorphine_initiation(1, 1, 10, 0, 1)

# Example 2: Precipitated Withdrawal Risk
# OUD Yes, Ready Yes, COWS 4 (Mild), Not Pregnant, Waiver Yes
embed_buprenorphine_initiation(1, 1, 4, 0, 1)

cliot documentation built on Dec. 1, 2025, 1:06 a.m.