Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department

• Published in: Drug and alcohol dependence Vol. 86; no. 2; pp. 239 - 244
• Main Authors: Berg, M.L, Idrees, U, Ding, R, Nesbit, S.A, Liang, H.K, McCarthy, M.L
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 12.01.2007; Elsevier Science
• Subjects: Academic Medical Centers; Addictive behaviors; Adult and adolescent clinical studies; Baltimore; Biological and medical sciences; Buprenorphine; Buprenorphine - therapeutic use; Drug addiction; Drug dependency; Emergency department; Emergency Service, Hospital; Emergency services; Heroin; Humans; Medical sciences; Narcotic Antagonists - therapeutic use; Opiate withdrawal; Opioid withdrawal; Opioid-Related Disorders - drug therapy; Opioids; Prescription opioids; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Substance Withdrawal Syndrome - drug therapy; Toxicology; Treatment; Urban Population; Withdrawal; Baltimore; Emergency department; Buprenorphine; Prescription opioids; Opiate withdrawal; Heroin; Opioid withdrawal; Human; Evaluation; Drug addiction; Replacement therapy; Poison withdrawal; Psychology; Use; Opiates; Narcotic analgesic; Addiction; Medical prescription; Drug of abuse; Psychiatry
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2006.06.014

Abstract Objectives To examine the use of buprenorphine for the treatment of opioid withdrawal (OW) in an emergency department (ED) setting. Methods The medical records of all adult patients who presented to the study ED during a 10 week period for OW were abstracted. Subjects were categorized as receiving buprenorphine, symptomatic treatment or no pharmacologic treatment for their OW. The three groups were compared by patient and service characteristics, withdrawal symptoms and outcomes. Results Of the 11,019 patients who presented to the ED during the 10 week study period, 158 (1.4%) were eligible. Subjects were more likely to receive buprenorphine (56%) compared to symptomatic treatment only (26%) or no pharmacologic treatment (18%). Subjects who received buprenorphine were more likely to have a history of suicide ideation (34% versus 12% p < 0.05) compared to subjects who received symptomatic treatment(s) and were less likely to present with a gastrointestinal complaint (9% versus 25% p < 0.05). Subjects who received buprenorphine were less likely to return to the same ED within 30 days for a drug-related visit (8%) compared to those who received symptomatic treatment (17%) ( p < 0.05). Conclusions Buprenorphine was a common treatment for OW in this ED without any documented adverse outcomes. Given that it did not result in an increase in drug-related return ED visits and its proven efficacy in other settings, a prospective evaluation of its potential value to ED patients who present with OW is warranted.