More ERs Are Providing Withdrawal Meds As First Step To Recovery

By Kelly Burch 08/22/18

Patients in need are receiving buprenorphine to address their withdrawal symptoms. 

Image: 
doctor inside of emergency room

Kicking an opioid habit comes with a host of physical withdrawal symptoms so severe that people often end up in the emergency room.

There, they are usually treated for diarrhea or vomiting, but not the underlying issue. Now, however, more emergency rooms around the county are providing buprenorphine to help ease withdrawal and get more people into treatment. 

“With a single ER visit we can provide 24 to 48 hours of withdrawal suppression, as well as suppression of cravings,” Dr. Andrew Herring, an emergency medicine specialist at Highland Hospital in Oakland, California, told The New York Times

At Highland, people who come in presenting with withdrawal symptoms are given a dose of buprenorphine, also known as Suboxone, and are told to follow up with Herring, who runs the hospital’s buprenorphine program. 

“It can be this revelatory moment for people—even in the depth of crisis, in the middle of the night,” Herring said. “It shows them there’s a pathway back to feeling normal.”

Although the Drug Enforcement Administration (DEA) requires doctors to receive special training and a license to prescribe buprenorphine, doctors in the ER can provide the medication without this training. Still, Herring said, many healthcare providers hesitate to provide the first step toward medication-assisted treatment (MAT). 

“At first it seemed so alien and far-fetched,” he said. 

Yet, research into the practice is promising. A 2015 study showed that people who were given buprenorphine in the ER were twice as likely to be in treatment 30 days later than those who were not given medication to help with withdrawal.  

“I think we’re at the stage now where emergency docs are saying, ‘I’ve got to do something,’” said Dr. Gail D’Onofrio, lead study author. “They’re beyond thinking they can just be a revolving door.”

California has plans to expand treatment for withdrawal in emergency rooms, using $78 million in federal funding to establish a hub-and-spoke system where people would get their first dose of medication in the emergency room before being connected with ongoing services.

Dr. Kelly Pfeifer, director of high-value care at the California Health Care Foundation, said this is the next step in providing quality care for people fighting addiction. 

“We don’t think twice about someone having a heart attack, getting stabilized in the emergency department, and then getting ongoing care from the cardiologist,” she said. “And the risk of death within a year after an overdose is greater than it is for a heart attack.”

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.

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