Management of Opioid Use Disorder in the Emergency Department: A White Paper Prepared for the American Academy of Emergency Medicine

Strayer, Reuben J.; Hawk, Kathryn; Hayes, Bryan D.; Herring, Andrew A.; Ketcham, Eric; LaPietra, Alexis; Lynch, Joshua; Motov, Sergey; Repanshek, Zachary; Weiner, Scott G.; Nelson, Lewis S.

doi:10.1016/j.jemermed.2019.12.034

Cited by 38 publications

(41 citation statements)

References 184 publications

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“…53 Sample protocols are available online, in EM textbooks, and on the ACEP Emergency Medicine Quality Network Opioid Initiative website. 38,49,50,[54][55][56] In contrast to traditional outpatient induction protocols and FDA labeling, 26 ED-based protocols often start with administration of at least 8 mg of buprenorphine for patients with clinical signs of opioid withdrawal, and some protocols include an option for 24 mg or more during the ED visit based on provider experience, buprenorphine and/or specialist consultation, or other factors. 38,49,50,[54][55][56]…”

Section: Protocolsmentioning

confidence: 99%

Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department

Hawk

Hoppe

Ketcham

et al. 2021

Annals of Emergency Medicine

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The treatment of opioid use disorder with buprenorphine and methadone reduces morbidity and mortality in patients with opioid use disorder. The initiation of buprenorphine in the emergency department (ED) has been associated with increased rates of outpatient treatment linkage and decreased drug use when compared to patients randomized to receive standard ED referral. As such, the ED has been increasingly recognized as a venue for the identification and initiation of treatment for opioid use disorder, but no formal American College of Emergency Physicians (ACEP) recommendations on the topic have previously been published. The ACEP convened a group of emergency physicians with expertise in clinical research, addiction, toxicology, and administration to review literature and develop consensus recommendations on the treatment of opioid use disorder in the ED. Based on literature review, clinical experience, and expert consensus, the group recommends that emergency physicians offer to initiate opioid use disorder treatment with buprenorphine in appropriate patients and provide direct linkage to ongoing treatment for patients with untreated opioid use disorder. These consensus recommendations include strategies for opioid use disorder treatment initiation and ED program implementation. They were approved by the ACEP board of directors in January 2021.

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Section: Protocolsmentioning

confidence: 99%

Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department

Hawk

Hoppe

Ketcham

et al. 2021

Annals of Emergency Medicine

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“…47,48 New induction protocols, including microdosing and higher initial buprenorphine doses, may also be effective in mitigating the risk of precipitated withdrawal due to protracted fentanyl washout periods. [49][50][51] The Bernese Method, for example, is an increasingly utilized microdosing protocol that involves starting a very low buprenorphine dose that is titrated to the therapeutic range over approximately 7-10 days, during which patients can continue to use full opioid agonists (including heroin/fentanyl), which are discontinued once a therapeutic dose of buprenorphine is reached. 52 Early data suggest that this protocol is well tolerated and does not result in precipitated withdrawal.…”

Section: Take a Patient-centered Approach To Moud Prescribingmentioning

confidence: 99%

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

et al. 2021

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Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care–based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care–based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06904-4.

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“…Initiation of buprenorphine in the ED has received support from major professional associations, 18 and an increasing number of EDs treat patients with OUD with buprenorphine and dispense take-home naloxone to at-risk patients and their companions. 19 The American College of Emergency Physicians (ACEP) has developed a Pain and Addiction Care in the ED Accreditation Program. The program ensures that patients receive quality pain management and provide the tools for an ED to initiate treatment for patients with OUD.…”

Section: Widespread Support and Implementationmentioning

confidence: 99%

“…Gaps exist in our knowledge about patient attitudes toward MOUD and the best practices, protocols, and workflows for EDIB. 19,58 Also, research is needed to improve real-time identification of at-risk patients using electronic health record machine learning and/or screening. 59,60 Research on innovative payment models may be necessary to improve care and coverage for people with OUD.…”

Section: Future Researchmentioning

confidence: 99%

Advancing emergency department–initiated buprenorphine

et al. 2021

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s spouse is eligible for a defined benefit plan (pension) through Pfizer from previous employment. Wilson Compton reports long-term stock holdings in General Electric Co., 3 M Companies, and Pfizer Inc. unrelated to this manuscript.Funding and support: By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.

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Management of Opioid Use Disorder in the Emergency Department: A White Paper Prepared for the American Academy of Emergency Medicine

Cited by 38 publications

References 184 publications

Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department

Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

Advancing emergency department–initiated buprenorphine

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