Core EM - Emergency Medicine Podcast

Episode 161.0 – Opioid Epidemic

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A look at the opioid epidemic and what ED providers can do to combat this formidable foe.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Opioid_Epidemic.mp3
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Tags: Opioid Dependence, Opioid Free ED
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

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