Emergency Medicine / Pain Management

ED-initiated Buprenorphine for Opioid-dependent Patients

June 20, 2016
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With an estimated 2 million people in the United States alone struggling with some form of opioid abuse disorder, many medical professionals are calling for proactive measures to aid in the reversal of opioid addiction rate trends.

One important step would be to curb the rates of new addicts by lowering rates of patients that get addicted to prescription opioid use. Drugs like naloxone and buprenorphine operate to alleviate many of the struggles of opium abuse. There is now growing support for emergency departments to offer buprenorphine and naloxone to opioid-dependent patients at the time of their discharge. This position is backed up by a recent study that demonstrates that initiation of buprenorphine can increase opioid dependent patients’ propensity to undergo addiction treatment. The trial, which randomized 229 patients among three groups, examined the differences between three distinct approaches to opioid-dependent patient discharge: the first being referral to treatment; the second including referral and brief intervention; and the third being referral, brief intervention, and buprenorphine/naloxone treatment. At the end of a month, it was clear that the third group, differentiated by its treatment with anti-opioid medication, was the most effective. Seventy-eight percent of the buprenorphine group remained committed to a treatment addiction program, compared to just 45% in the second group and 37% in the referral-only group. Patients in the buprenorphine group were also less likely to require in-patient addiction treatment and less susceptible to taking illicit opioids. On the whole, the data tended to trend towards greater intervention having more effective results, with the buprenorphine showing significantly better results by virtue of being a pharmacologic intervention. There was also no identified significant risk associated with the buprenorphine treatments, despite initial concerns that rates of HIV infections could be higher. HIV infection rates were not significantly differentiated among the three groups. The authors conclude that buprenorphine treatment initiated by hospitals’ emergency departments is a significantly more efficacious approach than simple referral or referral and intervention in minimizing the threat of opioid abuse disorder. These findings undoubtedly hold promise, but they require further analysis and replication of results to truly persuade the medical community. Nonetheless, this study potentially serves as an important piece of the response to the opioid addiction epidemic in the United States.