A look at the opioid epidemic and what ED providers can do to combat this formidable foe.



https://media.blubrry.com/coreem/content.blubrry.com/coreem/Opioid_Epidemic.mp3



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Tags: Opioid Dependence, Opioid Free ED





Show Notes

* Consider alternatives to opiates for acute pain

* NSAIDs
* Subdissociative ketamine
* Nerve blocks

* Curb misuse and diversion through prescribing a short supply and perform I-STOP checks
* Narcan is not just for acute overdose treatment by EMS or within the ED anymore

* We can equip patients, family members and friends with Narcan kits prior to discharge
* In New York state, can prescribe Narcan to patients with near fatal overdoses or who screen positive for an opioid use disorder
* Intranasal formulation is cheaper and more commonly prescribed than IM

* Buprenorphine induction can be done in the ED for patients in active withdrawal, as calculated by the COWS score.

* MDcalc calculator: https://www.mdcalc.com/cows-score-opiate-withdrawal
* Providers do not need an X-waiver to give a dose of Buprenorphine in the ED for 3 days

* Home induction can be considered for patients not actively withdrawing but would like to enter medication assisted treatment

* Some considerations:

* Contraindicated in patients with severe liver dysfunction and with hypersensitivity reaction to drug
* Oversedation can occur with concurrent use of benzodiazepines and alcohol
* Will precipitate withdrawal if concurrently using full opioid agonists

* Longitudinal care has to be established for patients started on Buprenorphine

* SAMHSA’s Buprenorphine practitioner locator site: https://www.samhsa.gov/medication-assisted-treatment/practitioner-program-data/treatment-practitioner-locator
* Buprenorphine Induction Pamphlet



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