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Strout TD, Baumann MR, Wendell LT. Understanding ED Buprenorphine Initiation for Opioid Use Disorder: A Guide for Emergency Nurses. J Emerg Nurs 2021; 47:139-154. [PMID: 33390217 DOI: 10.1016/j.jen.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
Opioid use disorder is a critical public health problem that continues to broaden in scope, adversely affecting millions of people worldwide. Significant efforts have been made to expand access to medication therapy for opioid use disorder, in particular buprenorphine. As the emergency department is a critical point of access for many patients with opioid use disorder, the initiation of buprenorphine therapy in the emergency department is increasing, and emergency nurses should be familiar with the care of these vulnerable patients. The purpose of this article is to provide a clinical review of opioid use disorder and opioid withdrawal syndrome, medication treatments for opioid use disorder, best clinical practices for ED-initiated buprenorphine therapy, assessment of withdrawal symptoms, discharge considerations, and concerns for special populations. With expanded understanding of opioid use disorder, withdrawal, and available treatments, emergency nurses will be better prepared to deliver and support life-saving treatments for patients and families suffering from this disease. In addition, emergency nurses are well positioned to play an important role in public health advocacy around opioid use disorder, providing critical support for destigmatization and expanded access to safe and efficacious treatments.
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Sullivan RW, Szczesniak LM, Wojcik SM. Bridge clinic buprenorphine program decreases emergency department visits. J Subst Abuse Treat 2021; 130:108410. [PMID: 34118702 DOI: 10.1016/j.jsat.2021.108410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Opioid withdrawal due to opioid use disorder (OUD) is an increasing health emergency and complaint in emergency departments (EDs) across the United States. As a response to the increased need for OUD treatment, a low threshold buprenorphine program, or Bridge Clinic, was established within our hospital system. Patients are primarily connected to the Bridge Clinic through the ED, and are able to complete their consultation appointment reliably within 1-3 days of referral. This program also serves to connect patients to community resources for continued treatment of OUD. METHODS A retrospective chart review was performed to identify ED-based referrals to the Bridge Clinic in the period from January 1, 2017 - December 31, 2018. Outcomes of interest included: (1) ED utilization in the six months before and after consultation at the Bridge Clinic and (2) adherence to buprenorphine therapy at 2-year follow-up. RESULTS A total of 269 patients were included in the study, with 167 males (62%) and a mean age of 37.8 years. There were 654 total visits to the ED six months before referral to the Bridge Clinic and 381 visits in the six-month period after the initial appointment. There was a high adherence to buprenorphine treatment at 2 year follow up (56%). CONCLUSIONS These early results suggest that prompt referral to a buprenorphine treatment program significantly reduces ED utilization and connects patients to community resources for continued buprenorphine treatment for OUD.
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Affiliation(s)
- Ross W Sullivan
- Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, USA.
| | | | - Susan M Wojcik
- Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, USA
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Dezfulian C, Orkin AM, Maron BA, Elmer J, Girotra S, Gladwin MT, Merchant RM, Panchal AR, Perman SM, Starks MA, van Diepen S, Lavonas EJ. Opioid-Associated Out-of-Hospital Cardiac Arrest: Distinctive Clinical Features and Implications for Health Care and Public Responses: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e836-e870. [PMID: 33682423 DOI: 10.1161/cir.0000000000000958] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Opioid overdose is the leading cause of death for Americans 25 to 64 years of age, and opioid use disorder affects >2 million Americans. The epidemiology of opioid-associated out-of-hospital cardiac arrest in the United States is changing rapidly, with exponential increases in death resulting from synthetic opioids and linear increases in heroin deaths more than offsetting modest reductions in deaths from prescription opioids. The pathophysiology of polysubstance toxidromes involving opioids, asphyxial death, and prolonged hypoxemia leading to global ischemia (cardiac arrest) differs from that of sudden cardiac arrest. People who use opioids may also develop bacteremia, central nervous system vasculitis and leukoencephalopathy, torsades de pointes, pulmonary vasculopathy, and pulmonary edema. Emergency management of opioid poisoning requires recognition by the lay public or emergency dispatchers, prompt emergency response, and effective ventilation coupled to compressions in the setting of opioid-associated out-of-hospital cardiac arrest. Effective ventilation is challenging to teach, whereas naloxone, an opioid antagonist, can be administered by emergency medical personnel, trained laypeople, and the general public with dispatcher instruction to prevent cardiac arrest. Opioid education and naloxone distributions programs have been developed to teach people who are likely to encounter a person with opioid poisoning how to administer naloxone, deliver high-quality compressions, and perform rescue breathing. Current American Heart Association recommendations call for laypeople and others who cannot reliably establish the presence of a pulse to initiate cardiopulmonary resuscitation in any individual who is unconscious and not breathing normally; if opioid overdose is suspected, naloxone should also be administered. Secondary prevention, including counseling, opioid overdose education with take-home naloxone, and medication for opioid use disorder, is important to prevent recurrent opioid overdose.
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Empowering Psychiatric Mental Health Nurse Practitioners to Expand Treatment Opportunities for Veterans With Opioid Use Disorder. J Addict Nurs 2020; 31:261-268. [PMID: 33264198 DOI: 10.1097/jan.0000000000000366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Few veterans with opioid use disorder receive effective treatment despite the Veterans Health Administration's efforts to expand treatment by offering buprenorphine, a medication to treat opioid use disorder (MOUD). An insufficient prescribing workforce contributes to the underutilization of buprenorphine; however, nurse practitioners (NPs) can now obtain a waiver to prescribe this medication. This quality improvement project aimed to expand the prescribing workforce by educating psychiatric mental health NPs (PMHNPs) working in an emergency setting at a Veterans Affairs Health Care System about free MOUD training and empowering them to utilize buprenorphine treatment. METHODS Eleven PMHNPs were asked for their perception of prescribing buprenorphine. They were asked if they had an MOUD waiver and/or were aware of the free waiver training. The PMHNPs were educated on the importance and process of obtaining the DEA-X waiver, and then a post-intervention discussion was completed to determine if they completed the waiver training. RESULTS At baseline, all 11 PMHNPs believed offering MOUD was important, but only three had the waiver to prescribe buprenorphine. After the education, three additional PMHNPs obtained the waiver and 10 planned to have the waiver in the next year. The department is planning to trial offering buprenorphine treatment, and PMHNPs at this facility are privileged to prescribe buprenorphine. In addition, five new PMHNP residents started or completed the training. CONCLUSIONS This project shows the potential to increase veteran access to MOUD by emphasizing education and empowering PMHNPs to initiate treatment. Providing education regarding the importance of buprenorphine treatment in the emergency setting and delivering information about the free waiver training facilitated workforce preparedness.
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Beauchamp GA, Laubach LT, Esposito SB, Yazdanyar A, Roth P, Lauber P, Allen J, Boateng N, Shaak S, Burmeister DB. Implementation of a Medication for Addiction Treatment (MAT) and Linkage Program by Leveraging Community Partnerships and Medical Toxicology Expertise. J Med Toxicol 2020; 17:176-184. [PMID: 33146875 DOI: 10.1007/s13181-020-00813-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Implementing a hospital medication for addiction treatment (MAT) and a linkage program can improve care for patients with substance use disorder (SUD); however, lack of hospital funding and brick and mortar SUD resources are potential barriers to feasibility. METHODS This study assesses the feasibility of implementation of a SUD linkage program. Components of the program include a county-funded hospital opioid support team (HOST), a hospital-employed addiction recovery specialist (ARS), and a medical toxicology MAT induction service and maintenance program. Data for linkage by HOST, ARS, and MAT program were tracked from July 2018 to December 2019. RESULTS From July 2018 through December 2019, 1834 patients were linked to treatment: 1536 by HOST and 298 by the ARS. The most common disposition categories for patients linked by HOST were 16.73% to medically monitored detoxification, 9.38% to intensive outpatient, and 8.59% to short-term residential treatment. Among patients linked by the ARS, 65.66% were linked to outpatient treatment and 9.43% were linked directly to inpatient treatment. A total of 223 patients managed by the ARS were started on MAT by medical toxicology and linked to outpatient MAT clinic: 72.68% on buprenorphine/naloxone, 24.59% on naltrexone, 1.09% buprenorphine, and 0.55% acamprosate. CONCLUSION Implementing a MAT and linkage program in the ED and hospital setting was feasible. Leveraging medical toxicology expertise as well as community and funding partnerships was crucial to successful implementation.
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Affiliation(s)
- Gillian A Beauchamp
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA. .,Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA.
| | - Lexis T Laubach
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Samantha B Esposito
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Ali Yazdanyar
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Paige Roth
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Priyanka Lauber
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Jamie Allen
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
| | - Nathan Boateng
- Air Products Center for Connected Care and Innovation, Lehigh Valley Health Network, Allentown, PA, USA
| | - Samantha Shaak
- Department of Community Health, Lehigh Valley Health Network, Allentown, PA, USA
| | - David B Burmeister
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Cedar Crest Blvd & I-78, Allentown, PA, 18103, USA
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Kaczorowski J, Bilodeau J, Orkin A, Dong K, Daoust R, Kestler A. Emergency Department-initiated Interventions for Patients With Opioid Use Disorder: A Systematic Review. Acad Emerg Med 2020; 27:1173-1182. [PMID: 32557932 DOI: 10.1111/acem.14054] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The opioid crisis has risen dramatically in North America in the new millennium, due to both illegal and prescription opioid use. While emergency departments (EDs) represent a potentially strategic setting for interventions to reduce harm from opioid use disorder (OUD), the absence of a recent synthesis of literature limits implementation and scalability. To fill this gap, we conducted a systematic review of the literature on interventions targeting OUDs initiated in EDs. METHODS Using an explicit search strategy (PROSPERO), the MEDLINE, CINAHL Complete, EMBASE, and EBM reviews databases were searched from 1980 to October 4, 2019. The gray literature was explored using Google Scholar. Study characteristics were abstracted independently. The methodologic quality and risk of bias were assessed. RESULTS Twelve of 2,270 studies met the inclusion criteria (two of high quality). In addition to the heterogeneity of the outcome measures used (retention in treatment, opioid consumption, and overdose), brief intervention and buprenorphine initiation (six of 12 studies) were the most documented with mixed effects for the former and positive short-term and confined to single ED sites effects for the latter. CONCLUSION Emergency departments can be an appropriate setting for initiating opioid agonist treatment, but to be sustained, it likely needs to be coupled with community-based follow-up and support to ensure longer-term retention. The scarcity of high-quality evidence on OUD interventions initiated in emergency settings highlights the need for future research.
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Affiliation(s)
- Janusz Kaczorowski
- From the Département de Médecine de Famille et Médecine d'Urgence Université de Montréal Montréal Québec Canada
- the Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM) Université de Montréal Montréal Québec Canada
| | - Jaunathan Bilodeau
- the Centre de recherche du centre hospitalier de l'Université de Montréal (CRCHUM) Université de Montréal Montréal Québec Canada
| | - Aaron Orkin
- the Department of Family & Community Medicine University of Toronto Toronto Ontario Canada
| | - Kathryn Dong
- the Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Raoul Daoust
- From the Département de Médecine de Famille et Médecine d'Urgence Université de Montréal Montréal Québec Canada
- the Centre de recherche de l’Hôpital Sacré‐Coeur de Montréal Montréal Québec Canada
| | - Andrew Kestler
- and the Department of Emergency Medicine University of British Columbia Vancouver British Columbia Canada
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LeSaint KT, Klapthor B, Wang RC, Geier C. Buprenorphine for Opioid Use Disorder in the Emergency Department: A Retrospective Chart Review. West J Emerg Med 2020; 21:1175-1181. [PMID: 32970572 PMCID: PMC7514395 DOI: 10.5811/westjem.2020.6.46452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/11/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Emergency care providers routinely treat patients with acute presentations and sequelae of opioid use disorder. An emergency physician and pharmacist implemented a protocol using buprenorphine for the treatment of patients with opioid withdrawal at an academic, Level I trauma center. We describe our experience regarding buprenorphine implementation in the emergency department (ED), characteristics of patients who received buprenorphine, and rates of outpatient follow-up. Methods We conducted a retrospective chart review of all patients in the ED for whom buprenorphine was administered to treat opioid withdrawal during an 18-month period from January 30, 2017–July 31, 2018. Data extraction of a priori-defined variables was recorded. We used descriptive statistics to characterize the cohort of patients. Results A total of 77 patients were included for analysis. Thirty-three patients (43%) who received buprenorphine did not present with the chief complaint of opioid withdrawal. Most patients (74%) who received buprenorphine last used heroin, and presented in moderate opioid withdrawal. One case of precipitated withdrawal occurred after buprenorphine administration. Twenty-three (30%) patients received outpatient follow-up. Conclusions This study underscores the safety of ED-initiated buprenorphine and that buprenorphine administration in the ED is feasible and effective.
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Affiliation(s)
- Kathy T LeSaint
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Brent Klapthor
- Kaiser Permanente San Diego Medical Center, Department of Emergency Medicine, San Diego, California
| | - Ralph C Wang
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Curtis Geier
- University of California, San Francisco, Department of Clinical Pharmacy, San Francisco, California
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Medications for addiction treatment initiated from the emergency department: Ethical considerations. Am J Emerg Med 2020; 38:343-348. [DOI: 10.1016/j.ajem.2019.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 02/05/2023] Open
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Wagner KD, Oman RF, Smith KP, Harding RW, Dawkins AD, Lu M, Woodard S, Berry MN, Roget NA. “Another tool for the tool box? I'll take it!”: Feasibility and acceptability of mobile recovery outreach teams (MROT) for opioid overdose patients in the emergency room. J Subst Abuse Treat 2020; 108:95-103. [DOI: 10.1016/j.jsat.2019.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
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Treating Opioid Withdrawal With Buprenorphine in a Community Hospital Emergency Department: An Outreach Program. Ann Emerg Med 2020; 75:49-56. [DOI: 10.1016/j.annemergmed.2019.08.420] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/01/2019] [Accepted: 08/09/2019] [Indexed: 01/03/2023]
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Babu KM, Lai JT, Cushman PA, Monfreda A, Sanseverino AM, Dinapoli M, Gonzalez G. An emergency department order set for buprenorphine-naloxone (SUBOXONE ®) initiation. TOXICOLOGY COMMUNICATIONS 2019. [DOI: 10.1080/24734306.2019.1704978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Kavita M. Babu
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeffrey T. Lai
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Phoebe A. Cushman
- Division of General Internal Medicine, Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony Monfreda
- Department of Informatics, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Alexandra M. Sanseverino
- Division of Informatics, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Michael Dinapoli
- Department of Pharmacy, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Gerardo Gonzalez
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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High PM, Marks K, Robbins V, Winograd R, Manocchio T, Clarke T, Wood C, Stringer M. State targeted response to the opioid Crisis grants (opioid STR) program: Preliminary findings from two case studies and the national cross-site evaluation. J Subst Abuse Treat 2019; 108:48-54. [PMID: 31303359 DOI: 10.1016/j.jsat.2019.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/18/2019] [Accepted: 06/10/2019] [Indexed: 12/20/2022]
Abstract
Opioid misuse is a national health crisis that requires sustained treatment, prevention, and recovery efforts. This study evaluates the innovative treatment approaches that two states - Kentucky and Missouri - implemented in their states using State Targeted Response to the Opioid Crisis Grant (Opioid STR) program funds from the Substance Abuse Mental Health and Services Administration (SAMHSA), as well as preliminary findings from the Opioid STR national, cross-site evaluation that is funded and managed by SAMHSA. The Kentucky approach discusses the Emergency Department (ED) bridge model, which links patients discharged from EDs to appropriate professional treatment and recovery services. Missouri implemented the Medication First (MedFirst) model, an evidence-based treatment for individuals with opioid use disorder (OUD). These states highlight novel approaches likely being implemented throughout the country to combat the opioid epidemic. Findings from the case studies and supported by the national evaluation indicate that key factors to successful program implementation - supportive state policies, partnerships and collaborations, and sustainability - facilitated the implementation of planned interventions. The novel approaches discussed combined with care across the continuum (prevention, treatment and recovery) and continued federal support is likely to have an impact on reducing opioid misuse across the U.S.
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Affiliation(s)
- Patrick M High
- Substance Abuse and Mental Health Services Administration, United States of America
| | - Katherine Marks
- University of Kentucky, Department of Behavioral Science, United States of America; Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities, United States of America
| | - Vestena Robbins
- Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities, United States of America
| | - Rachel Winograd
- University of Missouri St. Louis, Missouri Institute of Mental Health, United States of America
| | - Teresa Manocchio
- Substance Abuse and Mental Health Services Administration, United States of America
| | - Thomas Clarke
- Substance Abuse and Mental Health Services Administration, United States of America.
| | - Claire Wood
- University of Missouri St. Louis, Missouri Institute of Mental Health, United States of America
| | - Mark Stringer
- Missouri Department of Mental Health, United States of America
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Wax PM, Stolbach AI, Schwarz ES, Warrick BJ, Wiegand TJ, Nelson LS. ACMT Position Statement: Buprenorphine Administration in the Emergency Department. J Med Toxicol 2019; 15:215-216. [PMID: 31087272 DOI: 10.1007/s13181-019-00712-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Paul M Wax
- University of Texas Southwestern, Dallas, TX, USA.
| | | | - Evan S Schwarz
- Division of Emergency Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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Herring AA, Perrone J, Nelson LS. Managing Opioid Withdrawal in the Emergency Department With Buprenorphine. Ann Emerg Med 2019; 73:481-487. [DOI: 10.1016/j.annemergmed.2018.11.032] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Indexed: 11/28/2022]
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Scheuermeyer FX, Grafstein E, Buxton J, Ahamad K, Lysyshyn M, DeVlaming S, Prinsloo G, Van Veen C, Kestler A, Gustafson R. Safety of a Modified Community Trailer to Manage Patients with Presumed Fentanyl Overdose. J Urban Health 2019; 96:21-26. [PMID: 30324356 PMCID: PMC6391297 DOI: 10.1007/s11524-018-0321-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Opioid overdoses (OD) cause substantial morbidity and mortality globally, and current emergency management is typically limited to supportive care, with variable emphasis on harm reduction and addictions treatment. Our urban setting has a high concentration of patients with presumed fentanyl OD, which places a burden on both pre-hospital and emergency department (ED) resources. From December 13, 2016, to March 1, 2017, we placed a modified trailer away from an ED but near the center of the expected area of high OD and accepted low-risk patients with presumed fentanyl OD. We provided OD treatment as well as on-site harm reduction, addictions care, and community resources. The primary outcome was the proportion of patients requiring transfer to an ED for clinical deterioration, while secondary outcomes were the proportion of patients initiated on opioid agonists and provided take-home naloxone kits. We treated 269 patients with opioid OD, transferred three (1.1%) to a local ED, started 43 (16.0%) on opioid agonists, and provided 220 (81.7%) with THN. Our program appears to be safe and may serve as a model for other settings dealing with a large numbers of opioid OD.
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Affiliation(s)
| | - Eric Grafstein
- St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Jane Buxton
- St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Keith Ahamad
- St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Mark Lysyshyn
- St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Stan DeVlaming
- St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Gerrit Prinsloo
- St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | | | - Andrew Kestler
- St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Reka Gustafson
- St Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
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Hawk K, D'Onofrio G. Emergency department screening and interventions for substance use disorders. Addict Sci Clin Pract 2018; 13:18. [PMID: 30078375 PMCID: PMC6077851 DOI: 10.1186/s13722-018-0117-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 07/12/2018] [Indexed: 11/13/2022] Open
Abstract
The emergency department (ED) has long been recognized as providing critical access to the health care system for many, yet only in the past few decades has the ED visit been recognized as an opportunity to identify and link patients to care for substance use disorders (SUDs). This review explores the evidence for ED-based screening, psychosocial and pharmacological interventions, and linkage to treatment for the spectrum of SUDs including high risk alcohol use and alcohol, opioid, tobacco and other SUDs. Despite knowledge gaps, methodological challenges and some inconsistency across interventions studied, opportunities for EDs to improve the care of patients across the spectrum of SUDs are robust.
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Affiliation(s)
- Kathryn Hawk
- Department of Emergency Medicine, Yale University, 464 Congress Ave, Suite 260, New Haven, CT, 06519, USA.
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale University, 464 Congress Ave, Suite 260, New Haven, CT, 06519, USA
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