Emergency Department Treatment of Opioid Use Disorder
2021
From 2005 to 2014, US drug-related emergency department (ED) visits doubled, and from 2016 to 2017, US ED visits for opioid overdoses increased by nearly 30%. More than one in twenty people treated in the ED for a nonfatal opioid overdose will die within one year of their ED visit. Although evidence-based and cost-effective treatments for opioid use disorder (OUD) exist, there are substantial gaps in access. EDs offer an ideal setting to address this treatment gap by initiating OUD treatment, facilitating linkage to outpatient treatment, and providing harm reduction services. ED-initiated buprenorphine followed by office-based referral has been demonstrated to increase treatment engagement and reduce illicit opioid use. People with untreated OUD who are not in withdrawal during their ED visit can be provided with a prescription for buprenorphine and instructions for unobserved initiation. In addition to receiving treatment, all the patients with OUD should be provided with harm reduction education and take-home naloxone. First-line treatments of acute pain in patients with OUD include continuing addiction treatment medications, adjusting dosages of medications for OUD, NSAIDs, regional nerve blocks, low-dose ketamine, and administering or prescribing additional opioid agonists when necessary, in coordination with outpatient treatment providers.
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