Abstract
Background
The Emergency Department (ED) frequently treats patients with drug overdoses and is
an important resource for individuals with opioid use disorder who are seeking treatment.
Initiating medication-assisted treatment (MAT) in the ED seems to be an effective
way to link patients with opioid use disorder (OUD) to treatment programs. There is
ongoing discussion on the best approach to MAT in the ED setting.
Objective
Describe a new model for managing OUD in the ED.
Method
Information was obtained retrospectively from the electronic medical records of patients
seen in a large county tertiary care center’s Clinical Decision Unit (CDU) for OUD
between September 1, 2017 and February 6, 2018. Data were summarized descriptively.
Results
There were 18 different patients placed in the CDU during the study period. Ninety-five
percent were induced with buprenorphine-naloxone in the CDU. The median initial Clinical
Opioid Withdrawal Scale score at the time of induction was 10. The median total dose
of buprenorphine-naloxone that was administered was 8/2 mg. The median amount of time
spent in the CDU and ED combined was 23 h. Approximately (12/19) 63% of subjects went
to their initial follow-up appointment in clinic. Nine were still active in clinic
at 30 days and 4 were active at 6 months.
Conclusions
This retrospective chart review shows promising preliminary data for managing OUD
in an ED CDU. Such strategies have the potential to increase access to care in a vulnerable
patient population.
Keywords
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References
- Managing opioid withdrawal in the emergency department with buprenorphine.Ann Emerg Med. 2019; ([Epub ahead of print])https://doi.org/10.1016/j.annemergmed.2018.11.032
- Opioid overdose crisis.(Available at:)https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisisDate accessed: October 4, 2018
- Drug overdose deaths in the United States, 1999–2016.NCHS Data Brief. 2017; : 1-8
- The costs and consequences of three policy options for reducing heroin dependency.Drug Alcohol Rev. 2007; 26: 369-378
- Risk factors for relapse and higher costs among Medicaid members with opioid dependence or abuse: opioid agonists, comorbidities, and treatment history.J Subst Abuse Treat. 2015; 57: 75-80
- The evidence doesn’t justify steps by state Medicaid programs to restrict opioid addiction treatment with buprenorphine.Health Aff (Millwood). 2011; 30: 1425-1433
- Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.JAMA. 2015; 313: 1636-1644
- Home buprenorphine/naloxone induction in primary care.J Gen Intern Med. 2009; 24: 226-232
- Diagnostic and statistical manual of mental disorders.5th edn. American Psychiatric Association, Washington, DC2013
- The Clinical Opiate Withdrawal Scale (COWS).J Psychoactive Drugs. 2003; 35: 253-259
- Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument.Drug Alcohol Depend. 2009; 105: 154-159
- American Society of Addiction Medicine (ASAM) national practice guideline for the use of medications in the treatment of addiction involving opioid use.J Addict Med. 2015; 9: 358-367
- Patients more likely to engage in treatment at 30 days when given buprenorphine in the ED, referred for follow-up.ED Manag. 2015; 27: 92-95
- Cost-effectiveness of emergency department-initiated treatment for opioid dependence.Addiction. 2017; 112: 2002-2010
- Predictors of buprenorphine treatment success of opioid dependence in two Baltimore City grassroots recovery programs.Addict Behav. 2017; 73: 129-132
- Treating opioid addiction with buprenorphine-naloxone in community-based primary care settings.Ann Fam Med. 2007; 5: 146-150
- Buprenorphine maintenance treatment in a primary care setting: outcomes at 1 year.J Subst Abuse Treat. 2009; 37: 426-430
Article info
Publication history
Published online: May 03, 2019
Accepted:
March 16,
2019
Received in revised form:
March 8,
2019
Received:
October 11,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
