Discussion
SECONDARY
In this secondary analysis of EMBED trial data on ED initiation of buprenorphine in the setting of user-center CDS, exposure to other physicians who had initiated buprenorphine during the trial was associated with self-adoption of the practice, consistent with a social contagion effect. This was nonlinear, with subsequent exposures having a greater estimated HR than initial ones. These findings were present after controlling for associated factors, including health care system and clinician role. Health care systems showed substantial variation in HR for adoption (The factors identified as contributors to ED initiation of buprenorphine in this study extend prior qualitative research focused on barriers to buprenorphine prescribing. Previous survey and interview studiesThis study also extends prior quantitative work examining the uptake of practice after an intervention by using a time-to-event framework instead of reporting prevalence of the practice, as well as adjusting for health care system characteristics, physician characteristics, social connections, and study duration.