Buprenorphine initiation in ED safe, effective among patients with OUD who use fentanyl

1 Apr 2023 • Findings from a recrent study that has appeared in JAMA Network Open suggest that initiating buprenorphine in the ED to patients with opioid use disorder was safe, less than 1% of people experienced withdrawal when starting buprenorphine in the emergency department. Opioid use disorder (OUD) consists of an overpowering desire to use opioids, increased opioid tolerance, and withdrawal syndrome when discontinued.

  • The trial recruited adult patients with untreated moderate to severe opioid use disorder, opioid-positive and methadone-negative urine tests, and a Clinical Opiate Withdrawal Scale score greater than or equal to 4.
  • In this study, precipitated withdrawal was defined as when a patient demonstrated marked escalation by five points or more on the Clinical Opiate Withdrawal Scale within two hours of starting buprenorphine.
  • Researchers found that despite high fentanyl use prevalence – about 70% – among 1,200 people with opioid use disorder, precipitated withdrawal occurred in nine out of the total 1,200 people, or 0.76%, and only 1% of those who had used fentanyl.

The findings help to encourage the use of buprenorphine in patients with opioid use disorder and build upon existing evidence that administering buprenorphine in emergency departments helps people begin addiction treatment and that higher-dose buprenorphine (more than the standard upper limit of 16 mg) is safe and well tolerated in people with opioid use disorder experiencing withdrawal symptoms.

Source: JAMA Network Open | Read full story

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