Clinical Policy: Critical Issues Related to Opioids in Adult Patients Presenting to the Emergency Department

Hatten, Benjamin W.; Cantrill, Stephen V.; Dubin, J.; Ketcham, Eric; Runde, Daniel; Wall, Stephen P.; Wolf, Stephen J.

doi:10.1016/j.annemergmed.2020.06.049

Cited by 22 publications

(22 citation statements)

References 44 publications

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“…The authors recommended utilization of buprenorphine as opposed to methadone as a level C recommendation (box 2). 128 In contrast to expert recommendations that advise waiting until mild-to-moderate withdrawal symptoms occur before initiating buprenorphine, 129 a recent case series by Patel et al suggests that buprenorphine may be initiated prior to experiencing overt withdrawal. 106 Patel et al provide a protocol for initiating buprenorphine for postoperative pain in patients with OUD in the perioperative period.…”

Section: Withdrawal Assessment Subjectivementioning

confidence: 99%

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Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel

Kohan

Potru

Barreveld

et al. 2021

Reg Anesth Pain Med

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BackgroundThe past two decades have witnessed an epidemic of opioid use disorder (OUD) in the USA, resulting in catastrophic loss of life secondary to opioid overdoses. Medication treatment of opioid use disorder (MOUD) is effective, yet barriers to care continue to result in a large proportion of untreated individuals. Optimal analgesia can be obtained in patients with MOUD within the perioperative period. Anesthesiologists and pain physicians can recommend and consider initiating MOUD in patients with suspected OUD at the point of care; this can serve as a bridge to comprehensive treatment and ultimately save lives.MethodsThe Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, American Society of Anesthesiologists, American Academy of Pain Medicine, American Society of Addiction Medicine and American Society of Health System Pharmacists approved the creation of a Multisociety Working Group on Opioid Use Disorder, representing the fields of pain medicine, addiction, and pharmacy health sciences. An extensive literature search was performed by members of the working group. Multiple study types were included and reviewed for quality. A modified Delphi process was used to assess the literature and expert opinion for each topic, with 100% consensus being achieved on the statements and each recommendation. The consensus statements were then graded by the committee members using the United States Preventive Services Task Force grading of evidence guidelines. In addition to the consensus recommendations, a narrative overview of buprenorphine, including pharmacology and legal statutes, was performed.ResultsTwo core topics were identified for the development of recommendations with >75% consensus as the goal for consensus; however, the working group achieved 100% consensus on both topics. Specific topics included (1) providing recommendations to aid physicians in the management of patients receiving buprenorphine for MOUD in the perioperative setting and (2) providing recommendations to aid physicians in the initiation of buprenorphine in patients with suspected OUD in the perioperative setting.ConclusionsTo decrease the risk of OUD recurrence, buprenorphine should not be routinely discontinued in the perioperative setting. Buprenorphine can be initiated in untreated patients with OUD and acute pain in the perioperative setting to decrease the risk of opioid recurrence and death from overdose.

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Section: Withdrawal Assessment Subjectivementioning

confidence: 99%

“…Reprinted with permission Hatten et al128 *Figure2How to initiate buprenorphine for a patient with suspected opioid use disorder (OUD) in the perioperative period. *We do not recommend using this algorithm (eg, initiating buprenorphine) in patients with chronic pain who are currently being prescribed long-acting opioids in the perioperative period.…”

mentioning

confidence: 99%

Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel

Kohan

Potru

Barreveld

et al. 2021

Reg Anesth Pain Med

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“…3,12 The current opioid epidemic has led to several challenges in opioid administration, including optimal opioid selection, dosing regimen, and route in the ED and at discharge. 3,13…”

Section: When Are Opioids Indicated and Which Drug(s) Dose(s) And Routes Of Administration Are Preferred?mentioning

confidence: 99%

Pain management in the emergency department: a clinical review

Motov

Vlasica²,

Middlebrook³

et al. 2021

Clin Exp Emerg Med

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Pain is one of the most common reasons for patients to visit the emergency department. The ever-growing research on emergency department analgesia has challenged the current practices with respect to the optimal analgesic regimen for acute musculoskeletal pain, safe and judicious opioid prescribing, appropriate utilization of non-opioid therapeutics, and non-pharmacological treatment modalities. This clinical review is set to provide evidence-based answers to these challenging questions.

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“…Thus, the American College of Emergency Physicians Clinical Policy for adult patients stating that if deemed appropriate, only low‐dose, short‐acting opioids with a short duration of therapy should be prescribed applies to children as well. 38 …”

Section: Recommendations For Clinical Practice In the Edmentioning

confidence: 99%

“…This is supported by the literature that children in acute pain have their most severe pain controlled in that window. Thus, the American College of Emergency Physicians Clinical Policy for adult patients stating that if deemed appropriate, only low‐dose, short‐acting opioids with a short duration of therapy should be prescribed applies to children as well 38 …”

Section: Recommendations For Clinical Practice In the Edmentioning

confidence: 99%

Emergency department strategies to combat the opioid crisis in children and adolescents

et al. 2021

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The opioid crisis has greatly affected not only adults but also children as well. As clinicians develop effective approaches to minimize pain and distress in children, the risks and benefits of opioids must be carefully considered. Children of parents with opioid use disorder are also at risk of living in unstable environments, performing poorly academically, engaging in future drug use, and having increased stress, which affects their development before entering adulthood. This statement focuses on the effects of the opioid crisis on children and adolescents and is intended to inform institutional policies, improve education, advocate for evidence‐informed guidelines, and improve the care of children affected by the opioid epidemic who are seen in the emergency department.

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Clinical Policy: Critical Issues Related to Opioids in Adult Patients Presenting to the Emergency Department

Cited by 22 publications

References 44 publications

Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel

Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel

Pain management in the emergency department: a clinical review

Emergency department strategies to combat the opioid crisis in children and adolescents

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