Abstract
IntroductionEmergency care providers routinely treat patients with acute presentations and sequelae of opioid use disorder. An emergency physician and pharmacist implemented a protocol using buprenorphine for the treatment of patients with opioid withdrawal at an academic, Level I trauma center. We describe our experience regarding buprenorphine implementation in the emergency department (ED), characteristics of patients who received buprenorphine, and rates of outpatient follow-up.MethodsWe conducted a retrospective chart review of all patients in the ED for whom buprenorphine was administered to treat opioid withdrawal during an 18-month period from January 30, 2017–July 31, 2018. Data extraction of a priori-defined variables was recorded. We used descriptive statistics to characterize the cohort of patients.ResultsA total of 77 patients were included for analysis. Thirty-three patients (43%) who received buprenorphine did not present with the chief complaint of opioid withdrawal. Most patients (74%) who received buprenorphine last used heroin, and presented in moderate opioid withdrawal. One case of precipitated withdrawal occurred after buprenorphine administration. Twenty-three (30%) patients received outpatient follow-up.ConclusionsThis study underscores the safety of ED-initiated buprenorphine and that buprenorphine administration in the ED is feasible and effective.
Highlights
Emergency care providers routinely treat patients with acute presentations and sequelae of opioid use disorder
A total of 77 patients were included for analysis
Thirty-three patients (43%) who received buprenorphine did not present with the chief complaint of opioid withdrawal
Summary
Emergency care providers routinely treat patients with acute presentations and sequelae of opioid use disorder. As of 2017, 2.1 million Americans were suffering from opioid use disorder (OUD), a condition associated with a 20-fold increase in rates of early death.[1,2] While medications with proven benefit exist for the treatment of OUD, their use has not yet become widespread.[1,3,4] Emergency departments (ED) are a natural setting for the improvement of this care, as providers routinely treat patients with acute presentations and sequelae of OUD. Prior investigators have shown the potential of the ED as a critical point of access for patients suffering from OUD, finding that ED-initiated medications for opioid use disorder (MOUD) is feasible, efficacious, and associated with significantly increased rates of engagement in addiction treatment.[8] In the state of California, the California Bridge Program seeks to expand and increase access to MOUD.
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