Nav: Home

Medication-assisted treatment helps patients avoid opioid withdrawal complications

January 10, 2019

WASHINGTON, DC -- Much attention is given to opioid overdose, but opioid withdrawal is a high-risk period where patients could experience serious health complications or revert to misuse or abuse, according to a new clinical review in Annals of Emergency Medicine.

"If left untreated, opioid withdrawal commonly results in a return to high-risk opioid use, with greater risk of overdose or death following discharge," said Andrew Herring, MD, an emergency physician and Medical Director of the Substance Use Disorder Program for Highland Hospital in Alameda, California and review co-author. "MAT [medication-assisted treatment] administered in the emergency department helps patients avoid health complications and ease into longer-term treatment and recovery."

For patients in withdrawal, abstinence without medical intervention increases the likelihood of an overdose, according to the authors.

Withdrawal due to drug cessation can include physiological signs (nausea, vomiting, diarrhea, rapid heartbeat, sweating) or psychological symptoms (anxiety, cravings, pain, dizziness) and is not typically life-threatening, although it can be extremely uncomfortable. Severe withdrawal, especially following administration of an opioid antagonist such as naloxone, can include delirium or serious cardiovascular complications.

"Despite strong evidence supporting the benefit of MAT, approaches to post-overdose treatment vary substantially," said Jeanmarie Perrone, MD, Director of Medical Toxicology for the Department of Emergency Medicine at the University of Pennsylvania School of Medicine and co-author.

Although methadone is still used, buprenorphine is the preferred medication for most patients, especially in the emergency department. However, there is currently no definitive approach to dosing or consensus for the optimal initial dose, the authors note in the review titled, "Managing Opioid Withdrawal in the Emergency Department with Buprenorphine."

Short-term buprenorphine administration is permitted under the Three-Day Rule, which allows discharged patients to return daily (for three days) to the emergency department in order to receive medication, while a Drug Addiction Treatment Act (DATA) waiver is required for prescribing.

Providers with appropriate waivers can prescribe buprenorphine for the duration needed to ensure the next treatment. Any provider with Drug Enforcement Agency registration can apply for a waiver following an 8-hour training program and exam.

"A plan for rapid follow-up is recommended, especially if no waivered provider is available," said co-author Lewis Nelson, MD, Chair, Department of Emergency Medicine and Director, Medical Toxicology, Rutgers New Jersey Medical School. "This could include care coordinators, recovery coaches, or a 'warm handoff' to a long-term provider. Strong partnerships with other experts in the hospital and in the community encourage continuity of care after a patient is discharged."

"The current system of care for opioid use disorder is fragmented, which poses numerous challenges for patients and for providers. Initiating MAT in the emergency department enables more connected, continuous care, which can make all the difference in a patient's recovery," said Dr. Perrone.
-end-
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians (ACEP), the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

American College of Emergency Physicians

Related Emergency Department Articles:

Patient race & gender are important in predicting heart attack in the emergency department
Researchers at the George Washington University published research finding that certain symptoms are more and less predictive of patients' risk for acute coronary syndrome, which includes heart attack, in patients of different gender and race.
What are trends in emergency department utilization, costs for shingles?
A new article published by JAMA Dermatology uses a nationwide database of emergency department (ED) visits to examine herpes zoster (HZ, shingles)-related ED utilization and costs.
Many cancer patients' Emergency Department visits appear preventable
As many as 53 percent of cancer patients' Emergency Department visits that do not require admission could be avoided with better symptom management and greater availability of outpatient care tailored to their needs, according to a new study from Fred Hutchinson Cancer Research Center.
Lawn mower injuries send 13 children to the emergency department every day
A recent study from the Center for Injury Research and Policy at Nationwide Children's Hospital published in the American Journal of Emergency Medicine shows that, while there has been a decrease in the number of children injured by lawn mowers over the last few decades, this cause of serious injury continues to be a concern.
Cotton tip applicators are sending 34 kids to the emergency department each day
A study conducted by Nationwide Children's Hospital researchers found that over a 21-year period from 1990 through 2010, an estimated 263,000 children younger than 18 years of age were treated in US hospital emergency departments for cotton tip applicator related ear injuries -- that's about 12,500 annually, or about 34 injuries every day.
Regions with stronger gun laws have fewer gun-related pediatric emergency department visits
Regions of the United States with the strictest gun laws also have the fewest emergency department visits for pediatric firearm-related injuries, according to a new study by Children's National Health System researchers.
Intervention reduced suicide attempts among at-risk emergency department patients
Among suicidal patients, an intervention that included brief post-discharge phone calls significantly reduced the likelihood of a future suicide attempt, according to a clinical trial conducted at eight hospitals.
Study examines emergency department visits for patients injured by law enforcement in the US
From 2006 to 2012, there were approximately 51,000 emergency department visits per year for patients injured by law enforcement in the United States, with this number stable over this time period, according to a study published by JAMA Surgery.
Predicting a patient's future firearm violence risk in the emergency department
A new study, from researchers at Michigan Medicine, sought to provide emergency department physicians with a new clinical risk index tool to gauge firearm violence risk among urban youth.
Adolescents with autism four times more likely to visit emergency department
Adolescents with autism spectrum disorder (ASD) use emergency-department services four times as often as their peers without autism, according to Penn State College of Medicine researchers.

Related Emergency Department Reading:

The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the “No Wait” Department
by Jody Crane MD MBA (Author), Chuck Noon PhD (Author)

Avoiding Common Errors in the Emergency Department
by Amal Mattu MD (Editor), Arjun S. Chanmugam MD MBA (Editor), Stuart P. Swadron MD FRCP(C) FACEP (Editor), Dale Woolridge MD PhD (Editor), Michael Winters (Editor)

Fast Facts for the ER Nurse, Third Edition: Emergency Department Orientation in a Nutshell
by Jennifer R. Buettner RN (Author), Jennifer R. Buettner (Editor)

Excellence in the Emergency Department: How to Get Results
by Stephanie J. Baker (Author)

Strauss and Mayer’s Emergency Department Management
by Robert W. Strauss (Author), Thom A. Mayer (Author)

Strauss and Mayer's Emergency Department Management by Strauss, Robert W., Mayer, Thom A. (2014) Hardcover
by McGraw-Hill Medical (Publisher)

Tarascon Emergency Department Quick Reference Guide
by D. Brady Pregerson (Author)

Emergency Department Resuscitation of the Critically Ill, 2nd Edition
by MD, FACEP, FAAEM Michael E. Winters (Author)

The ABCs of Making it in the ED: A guide to becoming an asset in the emergency department for medical students, nurse practitioners, physician assistants, and resident physicians
by M.D., Jason A. Borton (Author)

Emergency Department Leadership and Management: Best Principles and Practice
by Stephanie Kayden (Editor), Philip D. Anderson (Editor), Robert Freitas (Editor), Elke Platz (Editor)

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Approaching With Kindness
We often forget to say the words "thank you." But can those two words change how you — and those around you — look at the world? This hour, TED speakers on the power of gratitude and appreciation. Guests include author AJ Jacobs, author and former baseball player Mike Robbins, Dr. Laura Trice, Professor of Management Christine Porath, and former Danish politician Özlem Cekic.
Now Playing: Science for the People

#509 Anisogamy: The Beginning of Male and Female
This week we discuss how the sperm and egg came to be, and how a difference of reproductive interest has led to sexual conflict in bed bugs. We'll be speaking with Dr. Geoff Parker, an evolutionary biologist credited with developing a theory to explain the evolution of two sexes, about anisogamy, sexual reproduction through the fusion of two different gametes: the egg and the sperm. Then we'll speak with Dr. Roberto Pereira, research scientist in urban entomology at the University of Florida, about traumatic insemination in bed bugs.