Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

Shift from Metabolize-to-Freedom to Medication-Assisted Treatment

By Sally Mahmoud-Werthmann, MD | on February 7, 2023 | 0 Comment
Features
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

“Metabolize to freedom” or “MTF” as it is commonly known to emergency physicians is too frequently the instructions that accompany sign out to a colleague. Alcohol use disorder (AUD), a preventable and treatable medical condition, results in over 2 million annual emergency department (ED) encounters, accruing an annual cost of $15 billion.1,2 Accounting for nearly 40 percent of all substance use related-ED visits in 2021, data suggests that alcohol-related ED visits are steadily increasing.3 Emergency departments faced with unprecedented boarding challenges cannot afford to ignore this persistent public health burden, particularly in light of evidence-based interventions and medications that can treat AUD.4

You Might Also Like
  • Medication-Assisted Therapy Is More Than Just Buprenorphine
  • ED-Initiated Medication-Assisted Therapy: 1 Hospital’s Experience
  • ED’s Shift To Physician-in-Triage Enabled Fast Assessment, Treatment
Explore This Issue
ACEP Now: Vol 42 – No 02 – February 2023

Yet, there remains a significant treatment gap for patients with AUD. Of the more than 18 million people in the United States who need treatment, fewer than 10 percent receive appropriate medication.5 Additionally, there is a significant evidence-practice gap. Even though a considerable body of literature demonstrates the benefits of using FDA-approved medications in the treatment of AUD, few emergency departments have a protocol in place to initiate these medications and help patients achieve goals of reduced alcohol consumption or abstinence.6 Intoxicated or withdrawing patients are observed until sobriety, treated for their acute complication, and ultimately discharged without addressing their underlying AUD.

Naltrexone and Acamprosate

Three medications are FDA-approved for the treatment of AUD—naltrexone, acamprosate, and disulfiram, and several others show off label benefit.7,8 Here I will focus on naltrexone and acamprosate, since those are both first-line treatments and have the best evidence supporting their benefits.9 Naltrexone, an opioid antagonist, is available in two formulations: oral daily naltrexone and intra-muscular, extended-release naltrexone (vivitrol) administered monthly.10 Naltrexone reduces heavy drinking and is an ideal option for patients who would like to reduce their alcohol consumption rather than quit.11 Vivitrol offers the added benefit of once-a-month dosing, which may positively impact compliance especially in patients who face socioeconomic barriers to access care.12 A recent study found that initiating vivitrol in the ED in collaboration with case management demonstrated significant reductions in overall alcohol consumption as well as improved quality of life. Importantly, nearly 80 percent of patients completed all follow up appointments and 69 percent of the patients continued vivitrol after the study.13 Another study found that in comparison to oral naltrexone, patients who received vivitrol in the ED had higher rates of follow up within 30 days. Of note, patients in both arms were seen by a substance use navigator.14

Pages: 1 2 3 | Single Page

Topics: acamprosateAddictionAlcoholalcohol use disordermedication-assisted therapymetabolize to freedom (MAT)naltrexone

Related

  • Problem Drinking Remains a Big Problem

    July 11, 2024 - 0 Comment
  • The New Mexico Bridge Program

    March 5, 2023 - 0 Comment
  • Dr. Alister Martin’s Medical Entrepreneurship for Equity

    February 10, 2023 - 0 Comment

Current Issue

ACEP Now: June 2025 (Digital)

Read More

No Responses to “Shift from Metabolize-to-Freedom to Medication-Assisted Treatment”

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603