Starting Suboxone Therapy in the ED for Opioid Abusers

Summary and Comment |
April 28, 2015

Starting Suboxone Therapy in the ED for Opioid Abusers

  1. Daniel J. Pallin, MD, MPH

ED patients who abuse opioids were much more likely to participate in addiction treatment when started on buprenorphine/naloxone in the ED.

  1. Daniel J. Pallin, MD, MPH

Emergency department (ED) management of opioid abuse is usually limited to management of emergent adverse events. Could we do more? Investigators at an urban hospital randomized 329 adult ED patients reporting opioid dependence to one of three interventions: referral to addiction treatment services; referral and brief ED counseling; or referral, ED counseling, and initiation of therapy with buprenorphine/naloxone (Suboxone), when indicated.

The rate of participation in addiction treatment at 30 days (the main outcome) was 78% in the buprenorphine/naloxone group, 45% in the ED counseling group, and 37% in the referral-only group. Of the three groups, 11%, 35%, and 37%, respectively, used inpatient addiction treatment services within 30 days. In addition, the buprenorphine/naloxone group had a greater reduction in self-reported illicit opioid use.

Comment

To confront addiction, all healthcare providers should intervene when it is practical to do so. For example, tobacco users should be counseled and offered nicotine substitutes. This study shows that the same approach works well for opioid abusers. Pending further study, this approach may be worth adopting nationwide.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel J. Pallin, MD, MPH at time of publication Grant / Research support NIH Leadership positions in professional societies Society for Academic Emergency Medicine (Co-Chair, Scientific Subcommittee of Program Committee)

Citation(s):

Reader Comments (6)

DAVID HILL Physician, Emergency Medicine, rural ED

If I had a reliable referral program that could get a patient in to long term treatment, then I think that ED prescription of Suboxone would be a useful tool.

James Recht, MD Physician, Psychiatry, community mental health clinic

Dr. McFadden is right on target. We desperately need regulatory changes that will facilitate more widespread understanding, acceptance and use of this potentially life-saving treatment modality.

NATHAN STRAHL

Kudos. I prescribe Suboxone, have 100 patients, upper limit. Five calls every day that I have to turn away. Yet I can prescribe any other narcotic in any amount to any number of patients I choose.

So I can create a problem on a large scale but fix a problem on a very limited scale.

Makes no sense.

thomas f kline md Physician, Family Medicine/General Practice, all over

why cant people get off this drug?. You would think so? why are there stories about robberies trying to get this this drug? street value? sounds like the heroin regustry in th UK Is there proof of substantial and actual "going clean" for one year after this wonder program designed by the national drug police?

Suzanne Rothchild Other Healthcare Professional, Obstetrics/Gynecology, prfivate office

Giving the patient's buprenorphine in the ED sounds nice, but they are unlikely to find an open program to get into treatment.The DEA limits each provider to 100 patients. For the ENTIRE state of Massachusetts there are only 717 physicians who are licensed
DATA waiver 2000 to prescribe it, and not all of them are active or they just treat their own patients. Seems like giving false hope.

dr ken mcfadden Physician, Emergency Medicine, community ER

I am not surprised by the results of this study. It again prompts me to advocate that the medical profession confront the DEA with regards to the prescribing policy for this unique combination agonist/antagonist drug. By the DEA prescribing rules we are not allowed to prescribe this medication without special education and even then only for the DEA's narrowly defined settings. The governing bodies of the NEJM, ACP, and ACEP should together demand a change in this policy to better serve our patients needs and not the moral self righteous needs of the DEA

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