Emergency Medical Minute26 Aug 2019

Colorado MAT Part 4: Buprenorphine in the Emergency Department

Treatment with buprenorphine is easier, less time consuming and far more effective for management of opioid withdrawal and OUD than standard care with clonidine, IVF, haldol and other symptomatic therapies.
Induction with buprenorphine is easy, requires no IV or labs, and is usually accomplished in 1-2 hours. It requires a chair, not a hospital bed.
To identify patients who are candidates, be sure they're in sufficient opioid withdrawal using clinical impression or the COWS scale, obtain a history of type of opioid use and time of last use and any prior experience with buprenorphine, and confirm patient consent for buprenorphine induction.
Precipitated withdrawal is a risk with induction if a patient is not sufficiently in withdrawal. Consensus on the treatment of precipitated withdrawal will require further study. Some protocols recommend stopping buprenorphine if withdrawal symptoms worsen, while others recommend treatment with additional doses of buprenorphine in addition to symptomatic meds.
Patients should be discharged with overdose education, naloxone and a plan for close follow-up with a warm handoff to an OTP or OBOT.
For adolescents 16 years old or older with OUD, buprenorphine is an option. For pregnant women, buprenorphine is a life-saver for both fetus and mother.
ED providers can be part of the solution to the opioid epidemic. Consistent appropriate use of buprenorphine in the ED has the potential to transform ED care of patients with OUD.

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