Practical takeaways for ED practice

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
    • SAMHSA’s Buprenorphine practitioner locator site: https://www.samhsa.gov/medication-assisted-treatment/practitioner-program-data/treatment-practitioner-locator
    • Buprenorphine Induction Pamphlet