Episode 161.0 – Opioid Epidemic

Core EM - Emergency Medicine Podcast

English - April 22, 2019 12:34 - 14 minutes - 13.3 MB - ★★★★★ - 128 ratings
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A look at the opioid epidemic and what ED providers can do to combat this formidable foe.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Opioid_Epidemic.mp3

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Tags: Opioid Dependence, Opioid Free ED

Show Notes

Consider alternatives to opiates for acute pain

NSAIDs
Subdissociative ketamine
Nerve blocks

Curb misuse and diversion through prescribing a short supply and perform I-STOP checks
Narcan is not just for acute overdose treatment by EMS or within the ED anymore

We can equip patients, family members and friends with Narcan kits prior to discharge
In New York state, can prescribe Narcan to patients with near fatal overdoses or who screen positive for an opioid use disorder
Intranasal formulation is cheaper and more commonly prescribed than IM

Buprenorphine induction can be done in the ED for patients in active withdrawal, as calculated by the COWS score.

MDcalc calculator: https://www.mdcalc.com/cows-score-opiate-withdrawal
Providers do not need an X-waiver to give a dose of Buprenorphine in the ED for 3 days

Home induction can be considered for patients not actively withdrawing but would like to enter medication assisted treatment

Some considerations:

Contraindicated in patients with severe liver dysfunction and with hypersensitivity reaction to drug
Oversedation can occur with concurrent use of benzodiazepines and alcohol
Will precipitate withdrawal if concurrently using full opioid agonists

Longitudinal care has to be established for patients started on Buprenorphine