Giving Addicted Patients Buprenorphine in the ER Works Better Than Referrals: Study

Emergenrcy room sign 4-29-15

Giving buprenorphine to patients addicted to opioids who are treated in the emergency room is more effective than simply providing them with a referral, a new study finds. Patients given buprenorphine were less likely to need in-patient treatment at a residential facility, HealthDay reports.

Buprenorphine helps control drug cravings and withdrawal symptoms. The study included 300 people who came to the emergency department (ED) for treatment related to prescription opioid or heroin use. The researchers compared three treatments for opioid addiction. One group received a list of available services, a second group received a motivational consultation and a referral, and the third group received a brief intervention and treatment with buprenorphine, which was continued in primary care.

“The patients who received ED-initiated medication and referral for ongoing treatment in primary care were twice as likely as the others to be engaged in treatment 30 days later,” lead researcher Gail D’Onofrio said in a news release. “They were less likely to use illicit opioids of any kind.”

Typically, emergency department doctors treating patients addicted to opioids “take care of the immediate concern, but don’t treat the underlying problem,” D’Onofrio said.

The study is published in the Journal of the American Medical Association.

A study published by Yale researchers last October found buprenorphine maintenance therapy is more effective than detoxification for patients being treated for prescription opioid dependence. The researchers said primary care doctors do not have evidence-based guidelines to decide between the two treatments.

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    vjmk

    April 30, 2015 at 2:34 PM

    I have given many people referrals for treatment. when they contact the place they get an appointment 30-60 days out. if all ED gave buprenorphine then more would select treatment. unfortunately that is not the case and when you are going through herion/opiate withdrawls 30 minutes much less 30 days seems like an eternity. there needs to be more treatment available to any and everyone who seeks it.

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    Lakepines

    April 30, 2015 at 1:13 PM

    It is interesting that the referral and brief intervention groups had poorly structured post-ED f/u and NO medical intervention (comfort) for withdrawal symptoms (eg non-opioid medications for withdrawal symptoms such as zofran, trazodone and clonidine as seen in our local treatment programs). The rate of acute withdrawal symptoms is noted for buprenorphine group but not for the other 2 groups. It is possible that attention to withdrawal symptoms w/o opioid replacement might be just as helpful as buprenorphine, especially with structured primary care or clinic f/u. It seems clear that the burprenorphine group had far more structure, likely a stronger positive expectancy (hope/placebo) from ED caregivers, and prompt relief from withdrawal symptoms (compassion).

    The outcomes leave much to be desired. 30 days is quite brief, and there was no f/u self-report of past 30 days of use of any of the extensive variety of other addictive substances noted at baseline, only of use of opioids. Also no self-report category for stimulants (methamphetamines illicit or pharmaceutical) or for ‘other’ substances such as K2, cathinones, Kratom, DXM, etc.

    The UDS rates were overall low, leaving questions about the status of those from whom UDS was not obtained. At least in our region the qualitative UDS’s may not detect Fentanyl (increasingly popular) or tramadol, and not always methadone. It would be nice to have a citation as to what could be detected and what could not by the qualitative screen used…and whether the screen could detect buprenorphine. If it could then negatives among those in the program would be an important measure.

    Finally the measure of engagement in treatment includes visits to buprenorphine clinics and this is not necessarily the same as AODA treatment addressing relapse prevention, emotional aspects of substance abuse, the risk of changing drug(s) of abuse, and the development of social support for reduced substance use. And if we do not know who was actually taking the buprenorphine, then the greater treatment involvement could be compliance being reinforced by continued prescriptions that could be abused (binging) or sold.

    I am concerned that this seems overall an inconclusive study of a very limited intervention for a very short time, with minimal in-depth clinical assessment at f/u.

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