Buprenorphine/naloxone initiation in the emergency department: A series of vignettes

Background: Opioid drug overdose deaths are at an all-time high. Buprenorphine, a medication used to treat opioid use disorder, has dramatic effects on mortality after overdose as well as engagement with outpatient treatment programs. Recent regulatory changes have eased barriers to prescription, ye...

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Bibliographic Details
Main Authors: Margarita Popova, Karen Chung, Sumitha Raman, Sonal Batra, Damali Nakitende, Keith Boniface
Format: Article
Language:English
Published: Elsevier 2024-12-01
Series:JEM Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2773232024000427
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Summary:Background: Opioid drug overdose deaths are at an all-time high. Buprenorphine, a medication used to treat opioid use disorder, has dramatic effects on mortality after overdose as well as engagement with outpatient treatment programs. Recent regulatory changes have eased barriers to prescription, yet buprenorphine is infrequently prescribed from the emergency department. Objectives: Emergency physicians see patients who would benefit from this medication on a regular basis. We aim to illustrate how buprenorphine can be initiated from the emergency department. Discussion: Using a series of six cases, the use of buprenorphine for common presentations of patients with opioid use disorder (OUD) is described. Conclusions: We present a series of clinical vignettes in order to increase emergency physicians’ familiarity and comfort with the use of buprenorphine/naloxone in the treatment of OUD. Patients with OUD treated with buprenorphine/naloxone are less likely to die from overdose and more likely to engage in long-term treatment. Emergency departments are well suited to initiate buprenorphine/naloxone for patients who are ready for change and eligible for medications for OUD. Now that barriers to prescribing have been removed, emergency clinicians should seek out patients with opioid use disorder who may benefit from this life-saving treatment, initiated either in the ED or at home.
ISSN:2773-2320