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Table 2 Participant quotes supporting facilitators to treating withdrawal and initiating buprenorphine

From: A qualitative examination of the current management of opioid use disorder and barriers to prescribing buprenorphine in a Canadian emergency department

1. Departmental champions support physician knowledge

 i. “I did not have formal training. Before [physician] came along and started working in our department, I never used it. I was aware it existed, but I never had any exposure. Once [physician] came along, they provided some guidelines on paper and gave some presentations to the group.” (Physician 1)

 ii. “I’ve never started it before, but I would be quite happy to start it now that there’s a order set that I can use and other colleagues that I work with that I can ask about it.” (Physician 5)

 iii. “I was able to prescribe [buprenorphine] with [physician] supporting me on What’sApp.” (Physician 19)

 iv. “You know it’s easy to approach [physician] and say, ‘here’s a situation I had, what do you think I could have done with that?’ So that is how I got my exposure.” (Physician 1)

 v. “[Physician] has also given us follow up stories, success stories essentially, of people who have followed up in the clinic and have significantly decreased their use of opioids. I found that very helpful.”(Physician 6)

2. Physician empowerment & patient satisfaction

 i. “I can describe two scenarios where the patient went from uncomfortable … just kind of “suffering through it” withdrawal where they know it is going to get worse … they went from feeling awful to smiling. One of them just shook my hand before leaving. He tracked me down and said thank you and then left, which is not necessarily part of my interaction with patients. It’s above and beyond to see that reaction in a patient. There are very few patients that feel that great when they leave the ED. I think it’s been quite positive.” (Physician 10)

 ii. “I don’t know what the outcomes are, I’ve heard they are good but the patient satisfaction when they leave the ED with an almost near resolution of their symptoms after one or two doses in most cases … it seems to be a positive from what I see.” (Physician 11)

 iii. “I’m giving someone who has a substance abuse issue a benzodiazepine and potent hypertensive medication to just go home with. I think they were never fully satisfied, and I was never satisfied with the interaction.” (Physician 7)

 iv. “It’s kind of fatiguing as a doctor to be like “No, I can’t fix this, I can’t fix that. We don’t do anything with this.” It is the helpless and useless which we do not like feeling. And so now that there is a tool in our hands, it has inspired us a bit. I feel this collectively in hearing how other people deal with patients. I think people feel a little bit more inspired to engage and to problem solve with patients, to counsel and positively support them … because we feel like we have something instead of nothing.” (Physician 19)

3. Order sets

 i. “Now that we have the order set, it makes it so much easier. It empowers people to use it because if someone looks at this, there are very straightforward including inclusion criteria, exclusion criteria. It’s become a lot easier to operationalize this knowledge not having to look it up on third party sources, about the proper dosing, the proper COWS threshold for instance, just all this stuff that we have had to find in other places. To have the institution and the Department behind a reviewed order set certainly empowered even myself. I think it has been a big change.” (Physician 12)

 ii. “We’ve got a good explanation hand out for patients and a good walk through for a physician with dosing suggestions and how to assess withdrawal. Given that it wasn’t part of my training formally, I’ve really found it helpful to have that resource.” (Physician 10)

4. Timely access to follow-up care

 i. “If there was no follow up for the patients, I wouldn’t go prescribing buprenorphine.” (Physician 2)

 ii. “It’s great when patients come in Monday evening, you can treat them accordingly and all they have to do is show up at a [follow-up clinic] at 9 am and an addiction specialist and a team will see them. I think that’s a great message to send to patients and its a great follow up plan that we have.” (Physician 12)

 iii. “If I’m sending patients with opioid withdrawal on [buprenorphine] on a Friday evening, then there’s a barrier to me saying they can see someone on Monday - I just feel its like too much time.”(Physician 11)