Beginning Buprenorphine in the Emergency Room
There is an interesting blog post by Dr. Jana Burson in which she discusses a recent study in the Journal of the American Medical Association (JAMA). The study occurred in the state of Connecticut, and it centered on providing patients a 3-day supply of buprenorphine when they presented in the ER and were found to be addicted to opiates.
Dr. Burson explains that of the 329 patients identified as opioid dependent, 34% of them cited “opioid addiction” as their presenting problem while the remaining patients presented with other general medical problems. The study aimed to test the theory that starting people on buprenorphine replacement therapy in the ER might facilitate successful follow-through with continued outpatient opioid treatment.
The study did produce confirmation of increased treatment involvement with 78% of the buprenorphine recipients being engaged in opioid outpatient treatment 30 days following their ER visit. Those who received only a treatment referral (but no buprenorphine support) had a treatment engagement percentage of just 37% thirty days after their ER visit.
Those that received the 3-day supply of buprenorphine in the ER were provided the option of continuing with 10 weeks of free buprenorphine therapy during their outpatient treatment participation. Buprenorphine is an opioid agonist that reduces or eliminates opioid withdrawal symptoms. It has long been shown that methadone and buprenorphine facilitate more thorough engagement in substance abuse treatment because the opioid agonist replacement medications essentially remove the painful withdrawal that interferes with the opioid addicted’s daily life.
Presently, very few areas of the country offer free buprenorphine medication to addicted people. It is however enlightening to see that medication-assisted therapy (MAT) yields a much higher percentage of treatment engagement among those with opioid addictions.
Emergency rooms across the country are continually besieged by individuals with opioid addictions – most of whom are trapped in a vicious cycle of daily opioid withdrawal. Enormous resources are being allocated to address opioid addiction in the ER when this addictive disorder can be more cost effectively treated and managed in a general outpatient substance abuse treatment setting.