Theoretically, if there is a low-affinity, high-potency opioid onboard such as heroin causing the overdose, I could give them buprenorphine, a higher-affinity, lower-potency opioid, and instead of causing precipitated withdrawal, it would cause precipitated breathing.
Explore This IssueACEP Now: Vol 37 – No 06 – June 2018
Let’s be clear: I am not telling you to start giving all your opioid overdose patients buprenorphine to wake them up. However, taking into account our newly understood pharmacology, this is a very plausible pathway that would allow a patient to be reversed from respiratory depression caused by heroin with the same medication that would stabilize and treat them.
As we continue to see more and more patients in the emergency department after an opioid overdose, we need to start thinking about issues other than reversal and discharge of these patients. We should be focusing on the stabilization and treatment of these patients, given the high mortality rate of continued utilization of illicit opioids.
It is incumbent upon us to start to use the basic forms of treatment that already exist, are in every hospital pharmacy in the country (or should be), and are a U.S. Food and Drug Administration-approved first-line treatment for this disease. Making a patient suffer from precipitated withdrawal from the naloxone is not teaching them a lesson, it is just mean!
Dr. Waller is a fellow at the National Center for Complex Health and Social Needs and managing partner at Complex Care Consulting LLC.
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In future articles in this series, we will delineate the best practices for treatment and approach in the emergency department. If you have questions or ideas, feel free to send them our way at firstname.lastname@example.org.
Buprenorphine for Treating Opioid Addiction in the Emergency Department
- If we just go back to the basic pharmacology of buprenorphine, we should realize this medication can safely stop acute withdrawal after naloxone.
- Buprenorphine comes in parenteral, sublingual, buccal mucosal, transdermal, implantable, and depo-injectable forms.
- The black-and-white labels of full agonist versus partial agonist are more myth than truth.
- Buprenorphine should be first-line therapy to stabilize a patient post opioid-overdose reversal with naloxone.
- Given the still increasing numbers of people suffering opioid overdoses, we must use an FDA-approved, available, safe treatment for a disease that’s the number-one killer of people younger than 50 years old.
- You do not need a special license to prescribe buprenorphine for opioid withdrawal treatment.
- If the patient is to be discharged, you do not need a special license to prescribe 72 hours of buprenorphine to stabilize the patient in order to get them to follow up for outpatient opioid-use disorder treatment.