Treatment with buprenorphine is easier, less
time consuming and far more effective for management of opioid
withdrawal and OUD than standard care with clonidine, IVF, haldol
and other symptomatic therapies.
Induction with buprenorphine is easy, requires
no IV or labs, and is usually accomplished in 1-2 hours. It
requires a chair, not a hospital bed.
To
identify patients who are candidates, be sure they’re in sufficient
opioid withdrawal using clinical impression or the COWS scale,
obtain a history of type of opioid use and time of last use and any
prior experience with buprenorphine, and confirm patient consent
for buprenorphine induction.
Precipitated withdrawal is a risk with
induction if a patient is not sufficiently in withdrawal. Consensus
on the treatment of precipitated withdrawal will require further
study. Some protocols recommend stopping buprenorphine if
withdrawal symptoms worsen, while others recommend treatment with
additional doses of buprenorphine in addition to symptomatic
meds.
Patients should be discharged with overdose
education, naloxone and a plan for close follow-up with a warm
handoff to an OTP or OBOT.
For
adolescents 16 years old or older with OUD, buprenorphineisan option. For pregnant women, buprenorphine is
a life-saver for both fetus and mother.
ED
providers can be part of the solution to the opioid epidemic.
Consistent appropriate use of buprenorphine in the ED has the
potential to transform ED care of patients with OUD.
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