When a person shows up at the emergency room with symptoms that show their blood sugar is through the roof, the doctor gets them going on insulin immediately after making a diagnosis of diabetes. It’s a no brainer, right?
Yet, why aren’t people who show up at the ER with an opioid use disorder – and there are tens of thousands of them doing so every day in America – treated the same way?
A new study offers the strongest evidence yet that they should be. Published in the Journal of General Internal Medicine, Yale University researchers found that people with opioid use are more likely to get into and remain in treatment if they are started on buprenorphine immediately at the ER.1
Buprenorphine, or Suboxone as it’s also known, is an opioid replacement therapy. While a pervasive misconception exists that going on Suboxone is no better than using heroin because it is still an opioid, the difference is that Suboxone can immediately reduce cravings, allowing those taking it to get into treatment and start reclaiming their lives.
Even people who are on opioid replacement therapy for extended periods are no longer considered to have an opioid use disorder if they can rebuild relationships, gain stable employment and care for their families. Physical dependency on a medication is not the same as a substance use disorder, where the activities of daily living become disrupted and dysfunctional.
Why Is Someone Who Overdosed Sent Home Without a Plan?
“Emergency department (ED)-based interventions typically focus on the acute stabilization and treatment of medical conditions, with the goal of ED care to engage patients in ongoing treatment,” the authors of the study, published in February, wrote.
“Similar to ED presentations of exacerbations of other chronic diseases such as diabetes and asthma, our results demonstrate that ED providers can initiate buprenorphine treatment for moderate/severe opioid use disorders and facilitate linkage to community-based providers including primary care and other office-based physicians who prescribe buprenorphine.”
A shocking truth is that, at this point, many people are then just sent home.
People with opioid use disorder can show up at an ER for many reasons. Commonly, they are brought in for an overdose, brought back by Narcan (naloxone), a lifesaving injectable medication that literally brings someone who overdosed back from the brink. They immediately “wake up” and start breathing again.
A shocking truth is that, at this point, many people are then just sent home. Usually, because of HIPAA laws, their loved ones might not have any idea the overdose even happened. Other times, an addict may present to an ED fishing for painkillers. An astute doctor might be able to recognize this and offer medication-assisted treatment and a referral to specialized addiction treatment right on the spot. Unfortunately, the reality is that emergency rooms continue to be missed opportunities for treatment.
If You End Up in the ER, Be Honest and Ask For Help
The Yale study randomized almost 300 patients at a large urban teaching hospital to three groups: ED-initiated buprenorphine with 10-week continuation in primary care, referral or brief intervention.
Among those given buprenorphine, 74 percent remained in treatment at two months, compared to just 53 percent of those given a referral to an addiction specialist, and 47 percent of those offered intervention services.
“At two months, the buprenorphine group reported significantly less illicit opioid use, with 1.1 days of illicit opioid use in the past seven days, compared to 1.8 in the referral group and two in the brief intervention group,” the authors wrote. “There was a significant temporal trend toward reduction in illicit opioid use in all groups from baseline to 12 months, but there were no longer between-group differences.”
For someone abusing opioids who has not had the misfortune of ending up in an emergency room yet, it’s worth nothing that if they were to, they may specifically request immediate buprenorphine treatment and a referral to specialized addiction treatment.
While many places simply focus on detoxing a person addicted to drugs and alcohol, it’s important to get to the root cause of why a person is using drugs in the first place. Most people who do so are self-medicating a co-occurring condition such as anxiety, depression or other psychological disorders. People who receive treatment for both issues concurrently have a much higher success rate in terms of maintaining long-term sobriety and good mental health.
D’Onofrio, G. et al. (2017, Feb. 13). Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention. Journal of General Internal Medicine.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.