Dr. Elyse Watkins
Opioid overdose deaths continue to rise, with over 500,000 people dying in the past twenty years. Associated mortality is high following an opioid-related emergency department visit, which has significantly increased over the years. As the opioid epidemic enters its fourth wave, it positions emergency department clinicians to offer treatment and linkage to care at a critical time for the underlying disease, opioid use disorder (OUD).
Clinical review of the efficacy of buprenorphine initiation for treating patients with OUD following an opioid overdose in the emergency department.
Current literature supports that emergency department-initiated buprenorphine is safe and effective, with superior adherence to addiction treatment programs following initiation. In a review of randomized controlled trials assessing continued addiction treatment at 30 days post-initiation, one reported that 78% of patients taking buprenorphine continued treatment, compared to 37% of patients who provided treatment referrals only. Compared to clonidine, patients administered buprenorphine also had a higher rate of continued therapy at 30 days. When evaluating patients 60 days post-initiation, one study showed that significantly more patients taking buprenorphine remained in treatment compared to patients that received a treatment referral or brief intervention within the ED (74% vs. 53% vs. 47%, respectively).
Buprenorphine has been proven safe and effective in treating OUD for decades; recent literature supports treatment initiation within the ED, identifying patients at elevated risk, and involving them in care prior to discharge. In a worsening opioid epidemic, emergency department treatment standards are quickly progressing. Further research is needed to guide protocol design and remaining barriers affecting or obstructing the broad implementation of ED-administered buprenorphine for treating OUD following an opioid overdose or opioid-related ED visit.
O'Donnell M. Meeting Patients Where They Are: A Review of Buprenorphine Administration in the Emergency Department. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2023; 5(2).
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