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Purpose The use of buprenorphine, methadone, and long-acting naltrexone for treatment of opioid use disorder (OUD) is discussed, including a review of current literature detailing treatment approaches and action steps to optimize treatment in acute care and office-based settings. Summary The U.S. epidemic of opioid-related deaths has been driven by misuse of prescription opioids and, increasingly, illicit drugs such as heroin, fentanyl, and fentanyl analogs, necessitating a refocusing of treatment efforts on expanding access to life-saving, evidence-based OUD pharmacotherapy. Inpatient treatment of opioid withdrawal includes acute symptom control through a combination of nonopioid medications and long-term pharmacotherapy to lessen opioid craving and facilitate stabilization and recovery. Methadone and buprenorphine reduce opioid craving, increase treatment retention, reduce illicit opioid use, and increase overall survival. Buprenorphine has logistical advantages over methadone, such as greater flexibility of treatment setting and less risk of adverse effects. Studies have shown the efficacy of long-acting injectable naltrexone to be comparable to that of buprenorphine if patients are detoxified prior to initiation of therapy; however, patients with active OUD are often not able to complete the week-long period of opioid abstinence needed prior to initiation of naltrexone injections. Although buprenorphine is preferred by many patients and can be prescribed in office-based settings, there remains a paucity of physicians certified to prescribe it. Conclusion Buprenorphine has become the medication of choice for many patients with OUD, but its use is limited by the low number of physicians certified to prescribe the agent. Other agents studied for treatment of OUD include methadone and naltrexone.

IntroductionBurnout syndrome is a prolonged response to chronic emotional and interpersonal stressors and is becoming an increasing concern in the medical community. Burnout in emergency medicine (EM) pharmacists has not been previously assessed.ObjectivesTo identify the prevalence of burnout among EM pharmacists, in addition to demographic, professional, seasonal, and job‐related associations.MethodsPharmacists practicing greater than 50% of their time in the emergency department (ED) setting were invited through the American College of Clinical Pharmacy Emergency Medicine Practice and Research Network listserv to complete a survey at three separate, 4‐week, time periods (July 2018, October 2018, and April 2019). The survey contained the Maslach Burnout Inventory for Medical Personnel to detect burnout. Questions regarding personal and job‐specific demographics were asked. Descriptive statistics were used to report demographics and burnout dimensions in each period. Spearman's rank correlation and univariate and multivariate analyses were performed to identify predictors of burnout and potential associations.ResultsA total of 485 surveys were completed across all periods (116 [July], 207 [October], 162 [April]) and response rates were 18.4%, 31.6%, and 22.7%, respectively. Burnout was identified in 69.8%, 67.1%, and 68.5% of respondents with no difference between periods. A majority of participants had high depersonalization scores (50.6‐76.3%) during the three survey periods.Younger age, more ED visits per year, level I trauma center designation, and lower percentage of direct patient care time were associated with increased odds of burnout in the July 2018 period. Intent to leave one's current position or the specialty of EM and consideration of a job with different hours had positive correlations with burnout.ConclusionsBurnout is prevalent in a majority of EM pharmacists throughout the year. It is difficult to identify exact predictors of burnout; however, potential contributors include age, trauma center designation, patient volumes, and direct patient care time.

With increasing rates of prescription drug abuse, OxyContin will continue to present challenges to physicians and health care providers. Physicians should be aware of potential patients who are seeking OxyContin for recreational use.

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PurposeTo evaluate the use of aztreonam as an active empiric therapy against subsequent culture of Pseudomonas aeruginosa (P. aeruginosa).MethodsThis was a retrospective cohort study conducted among patients who received either aztreonam or an antipseudomonal beta-lactam (BL) as an empiric therapy with subsequent culture with P. aeruginosa. All patients with at least one positive culture for P. aeruginosa between January 2014 and August 2016 were included in this analysis. The primary composite outcome was empiric therapy failure, defined as inappropriate empiric therapy, alteration of empiric antibiotic following culture results, or 30-day in-hospital mortality. Secondary outcomes included appropriate empiric therapy, alteration of empiric therapy, 30-day-in-hospital mortality, and post-culture hospital length of stay.ResultsThe primary outcome of empiric therapy failure was significantly higher in the aztreonam group than in the BL group (77.8% vs 41.9%; P=0.004). The aztreonam group had a lower rate of appropriate empiric therapy compared with the BL group (44.4% vs 66.1%; P=0.074) and higher alteration of empiric therapy once susceptibilities were known than when compared with the BL group (61.1%vs 28.2%; P=0.005). Although numerically higher, 30-day-in-hospital mortality and median hospital length of stay were not significantly different between the two groups.ConclusionEmpiric therapy failure occurred more often when initially using aztreonam vs a BL in a patient who subsequently had a P. aeruginosa infection. Only a third of patients within the aztreonam group had a documented BL allergy, demonstrating an inclination for clinicians to utilize this drug as an empiric therapy when there were more appropriate therapies available.

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