A practical review of buprenorphine utilization for the emergency physician in the era of decreased prescribing restrictions. [Review] - 2021

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSION: Emergency physicians can influence opioid related morbidity and mortality, by familiarizing themselves with the use of buprenorphine to treat opioid withdrawal and addiction, particularly now that prescribing restrictions have been eased. Further ED research is necessary to assess the optimal use of buprenorphine in this care setting. Copyright (c) 2021 Elsevier Inc. All rights reserved. DISCUSSION: Multiple studies have pointed to the effective use of buprenorphine as a treatment for OUDs in ED patients and are superior to standard care; however, there are various barriers to its use in the ED setting. INTRODUCTION: Opioid abuse and overdose deaths have reached epidemic proportions in the last couple decades. In response to rational prescribing initiatives, utilization of prescription opioids has decreased; however, the number of deaths due to opioid overdoses continues to rise, largely driven by fentanyl analogues in adulterated heroin. Solutions to the opioid crisis must be multifaceted and address underlying opioid addiction. In recent years, buprenorphine has become a cornerstone in the treatment of opioid use disorder (OUD) and initiation of therapy in the emergency department (ED) has become increasingly common. There have also been calls by many organizations to remove the requirement for additional training and X-waiver to prescribe buprenorphine. In April 2021, the Biden Administration eased prescribing restrictions on the drug. These initiatives are expected to increase ED utilization of the buprenorphine. The purpose of this paper is to provide an updated overview of the role and use of buprenorphine in the ED setting so physicians may adapt to the changing practice environment. OBJECTIVES: This is a narrative review describing the role of buprenorphine in the ED. A PubMed search was conducted using the keywords "opioid epidemic" "buprenorphine," and "medication assisted therapy", and "emergency department". All the articles that contained information on the opioid epidemic, medication assisted therapy, and the biological effects of buprenorphine, that were also relevant to pain management and the ED, were included in the review.


English

10.1016/j.ajem.2021.06.065 [doi] S0735-6757(21)00551-9 [pii]


*Analgesics, Opioid/tu [Therapeutic Use]
*Buprenorphine, Naloxone Drug Combination/tu [Therapeutic Use]
*Buprenorphine/tu [Therapeutic Use]
*Emergency Medicine
*Opiate Substitution Treatment/mt [Methods]
*Opioid-Related Disorders/dt [Drug Therapy]
Drug and Narcotic Control/lj [Legislation & Jurisprudence]
Humans


MedStar Washington Hospital Center


Emergency Medicine


Journal Article
Review