Impact of Racial Bias Training on Buprenorphine Administration in the Emergency Department

Racial disparities persist in access to evidence-based treatment for Opioid Use Disorder (OUD), particularly Medications for Opioid Use Disorder (MOUD) such as buprenorphine. Emergency departments (EDs), often the first contact point for patients in crisis, are a key setting where provider unconscious bias may influence MOUD administration. To address these disparities, New Detroit, a racial justice organization, developed Just Care, a racial bias training program for clinical providers in Southeast Michigan. The program aims to increase awareness of treatment disparities, strengthen patient-provider relationships, and promote equitable OUD care delivery through a two-part curriculum delivered over 16 months. We hypothesized that providers who completed the training would increase buprenorphine administration in the year following training compared with the year prior.

We conducted a retrospective chart review of buprenorphine administration by ED providers at an urban academic ED. We reviewed two 1-year periods from October 2021 – 2022 and March 2024 –2025, that were pre and post training, respectively. Providers were included if they completed the training and were employed during both periods. Cases were included if that patient was administered buprenorphine during the clinical course. Rates of administration per clinical shift were compared using Poisson rate analysis to generate incidence rates, rate ratios (RR), and 95% confidence intervals (CIs).

Eighteen providers (12 attending physicians, 6 physician assistants) met inclusion criteria. Across >184,000 encounters, trained clinicians administered buprenorphine 178 times across 2,193 shifts in the pre-training period (0.081 administrations/shift; 95% CI 0.070–0.094) and 258 times across 2,056 shifts in the post-training period (0.126 administrations/shift; 95% CI 0.112–0.142). The rate ratio was 1.55 (95% CI 1.27–1.89; p < 0.001), representing a 55% relative increase in buprenorphine administration after training.

Completion of the Just Care training was associated with increased ED buprenorphine administration in the year following training. These findings suggest that racial bias education for ED clinicians may support more equitable implementation of MOUD. Further research is needed to determine the effect of unconscious bias training on care delivery for patients with OUD.