Treatment Initiation for Opioid Use Disorder in Emergency Departments

MedicalResearch.com Interview with:

Herbie Duber, MD, MPH, FACEP Associate Professor, Emergency Medicine Adjunct Associate Professor Department of Global Health Adjunct Associate Professor, Institute for Health Metrics and Evaluation University of Washington

Dr. Duber

Herbie Duber, MD, MPH, FACEP
Associate Professor, Emergency Medicine
Adjunct Associate Professor Department of Global Health
Adjunct Associate Professor
Institute for Health Metrics and Evaluation
University of Washington

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Opioid use disorder (OUD) and opioid overdose deaths are a rapidly increasing public health crisis.  In this paper, we review and synthesize current evidence on the identification, management and transition of patients from the emergency department (ED) to the outpatient setting and present several key recommendations.

For patients identified to haveOpioid use disorder, we recommend ED-initiated mediation-assisted therapy (MAT) with buprenorphine, an opioid agonist.  Current evidence suggests that it safe and effective, leading to improved patient outcomes.  At the same time, a coordinated care plan should be put into motion which combines MAT with a rapid transition to outpatient care, preferably within 72 hours of ED evaluation.  Where possible, a warm handoff is preferred, as it has been shown in other settings to improve follow-up.  Outpatient care should combine MAT, psychological interventions and social support/case management in order to maximize impact

MedicalResearch.com: What should readers take away from your report? 

Response: The ED is a common place in which patients with Opioid use disorder interact with the medical system.  It is a missed opportunity not to more fully engage patients with OUD in the emergency department and consider therapy that includes MAT.  Current research supports the effectiveness and safety of buprenorphine when provided in the ED setting.  Developing a system of care that provides patients with the necessary support structure and medical therapy for Opioid use disorder is critical to curtailing the opioid epidemic.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research, some of which is already underway, will need to assess the feasibility and effectiveness of MAT in a wide range of ED settings-academic and community, rural and urban.  In addition, more research is required on how to most effectively and efficiently transition patients to the outpatient settings given the constraints of EDs with limited time and resources. 

Citation:

Identification, Management, and Transition of Care for Patients With Opioid Use Disorder in the Emergency Department
Duber, Herbert C. et al.
Annals of Emergency Medicine , Volume 0 , Issue 0 , 

 

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