Treating Opioid Withdrawal With Buprenorphine in a Community Hospital Emergency Department: An Outreach Program - 21/12/19
, Robert Wicelinski, DO a, Nicholas Gallagher, DO a, Alice McKinzie, DO b, Ryan White, DO b, Ann Domingos, LCSW-R, CASAC cAbstract |
Study objective |
We assess the feasibility of using our community hospital emergency department (ED) as an immediate portal to medication-assisted treatment for patients in opioid withdrawal.
Methods |
This was a prospective observational cohort study. In collaboration with an outpatient substance abuse treatment center, we alerted the public through media outlets that individuals could receive immediate buprenorphine treatment for opioid withdrawal in the ED, with rapid referral for medication-assisted treatment. If medication-assisted treatment intake was delayed, patients could return for up to 2 more days for buprenorphine administration to treat their withdrawal symptoms. We measured compliance with initial follow-up and continued treatment engagement at 30 and 90 days.
Results |
The study was conducted during 12 months. A total of 62 patients were enrolled, evaluated for buprenorphine criteria, and referred for medication-assisted treatment. Fifty subjects were compliant with their first medication-assisted treatment follow-up visit (81% [95% confidence interval 71% to 91%]), and 43 of these 50 patients were still engaged in medication-assisted treatment at 30 days (86% [95% confidence interval 76% to 96%]), with 33 of the 50 still engaged at 90 days (66% [95% confidence interval 53% to 79%]). We observed no instances of precipitated withdrawal or other adverse reactions in the ED.
Conclusion |
A substantial number of patients responded to this program and received accelerated engagement in medication-assisted treatment. Such a program is feasible in the community hospital ED and may prevent some individuals from relapsing into high-risk illicit drug use when immediate medication-assisted treatment is not otherwise available.
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| Please see page 50 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Richard C. Dart, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: FJE conceived the study. FJE, RW, NG, AM, RW, and AD were responsible for study design, analysis, and interpretation of data. FJE, RW, and NG were responsible for drafting the article. RW, NG, and AD were responsible for data aquisition. All authors were responsible for critical review, revision, and final approval of the article. FJE takes responsibility for the article as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was supported by a grant from New York State’s Care Compass Network. |
Vol 75 - N° 1
P. 49-56 - janvier 2020 Retour au numéro
Article précédent
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