Abstract
Introduction
Opioid use disorder (OUD) is increasing in prevalence throughout the world, with approximately
three million individuals in the United States affected. Buprenorphine is a medication
designed, researched, and effectively used to assist in OUD recovery.
Objective
This narrative review discusses an approach to initiating buprenorphine in the emergency
department (ED) for opioid-abuse recovery.
Discussion
Buprenorphine is a partial mu-opioid receptor agonist with high affinity and low intrinsic
activity. Buprenorphine's long half-life, high potency, and ‘ceiling effect’ for both
euphoric sensation and adverse effects make it an optimal treatment alternative for
patients presenting to the ED with opioid withdrawal. While most commonly provided
as a sublingual film or tablet, buprenorphine can also be delivered via transbuccal,
transdermal, subdermal (implant), subcutaneous, and parenteral routes. Prior to ED
administration, caution is recommended to avoid precipitation of buprenorphine-induced
opioid withdrawal. Following the evaluation of common opioid withdrawal symptoms,
a step-by-step approach to buprenorphine can by utilized to reach a sustained withdrawal
relief. A multimodal medication-assisted treatment (MAT) plan involving pharmacologic
treatment, as well as counseling and behavioral therapy, is essential to maintaining
opioid remission. Patients may be safely discharged with safe-use counseling, close
outpatient follow-up, and return precautions for continued management of their OUD.
Establishing a buprenorphine program in the ED involves a multifactorial approach
to establish a pro-buprenorphine culture.
Conclusions
Buprenorphine is an evidence-based, safe, effective treatment option for OUD in an
ED-setting. Though successfully utilized by many ED-based treatment programs, the
stigma of ‘replacing one opioid with another’ remains a barrier. Evidence-based discussions
on the safety and benefits of buprenorphine are essential to promoting a culture of
acceptance and optimizing ED OUD treatment.
Keywords
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Article Info
Publication History
Published online: October 11, 2018
Accepted:
October 10,
2018
Received in revised form:
October 8,
2018
Received:
July 29,
2018
Identification
Copyright
Published by Elsevier Inc.
