Beyond Buprenorphine: Models of Follow-up Care for Opioid Use Disorder in the Emergeny Department

Martin, Andrew; Butler, Kelley; Chavez, Tyler J.; Herring, Andrew A.; Wakeman, Sarah E.; Hayes, Bryan D.; Raja, Ali S.

doi:10.5811/westjem.2020.7.46079

Cited by 34 publications

(16 citation statements)

References 16 publications

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“…To rebuild and maintain trust between these communities, addressing burnout, trauma, and fatigue among professional first responders and healthcare providers due, in part, to increased exposure to fentanyl-related overdose events is imperative [9,44]. Care and intervention following a non-fatal fentanyl overdose can establish an avenue for continued care, and connection to post-overdose services, such as initiation on MOUD, connection to peer recovery support specialists, and access to medical and social care [45,46]. These results add to the existing literature by highlighting that hesitancy to engage with law enforcement and healthcare providers remains a factor that influences overdose response practices, despite increasing exposure to fentanyl-related overdoses and increasing fentanyl prevalence in the Western US drug supply.…”

Section: Discussionmentioning

confidence: 99%

“It wasn’t here, and now it is. It’s everywhere": fentanyl’s rising presence in Oregon’s drug supply

Shin¹,

LaForge²,

Stack³

et al. 2022

Harm Reduct J

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Background Illicit fentanyl has contributed to a drastic increase in overdose drug deaths. While fentanyl has subsumed the drug supply in the Northeastern and Midwestern USA, it has more recently reached the Western USA. For this study, we explored perspectives of people who use drugs (PWUD) on the changing drug supply in Oregon, experiences of and response to fentanyl-involved overdose, and recommendations from PWUD to reduce overdose risk within the context of illicit fentanyl’s dramatic increase in the recreational drug supply over the past decade. Methods We conducted in-depth interviews by phone with 34 PWUD in Oregon from May to June of 2021. We used thematic analysis to analyze transcripts and construct themes. Results PWUD knew about fentanyl, expressed concern about fentanyl pills, and were aware of other illicit drugs containing fentanyl. Participants were aware of the increased risk of an overdose but remained reluctant to engage with professional first responders due to fear of arrest. Participants had recommendations for reducing fentanyl overdose risk, including increasing access to information, harm reduction supplies (e.g., naloxone, fentanyl test strips), and medications for opioid use disorder; establishing drug checking services and overdose prevention sites; legalizing and regulating the drug supply; and reducing stigma enacted by healthcare providers. Conclusion PWUD in Oregon are aware of the rise of fentanyl and fentanyl pills and desire access to tools to reduce harm from fentanyl. As states in the Western USA face an inflection point of fentanyl in the drug supply, public health staff, behavioral health providers, and first responders can take action identified by the needs of PWUD.

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Section: Discussionmentioning

confidence: 99%

“It wasn’t here, and now it is. It’s everywhere": fentanyl’s rising presence in Oregon’s drug supply

Shin¹,

LaForge²,

Stack³

et al. 2022

Harm Reduct J

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“…Available outpatient clinics that continue MAT are independent of emergency medicine physicians’ abilities and scope of practice, but maintaining close relationships with these facilities and widespread distribution of information on available resources is critical to MAT’s success. Many EDs have had success in starting their own ED-based MAT clinics but have required extensive hospital support [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…While the practicality and success of utilizing the ED to initiate MAT have been demonstrated in previous works [ 18 , 19 ], large-scale support of and participation with this model is lacking. Medications to start MAT can be difficult to access even for highly motivated individuals, mainly due to a shortage of prescribers and treatment programs [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department

Logan¹,

Mirajkar²,

Houck³

et al. 2021

Cureus

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We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. MethodsThis was a cross-sectional survey study of American emergency medicine (EM) physicians with a selfadministered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. ResultsThere were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). ConclusionBarriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings.

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“…138 A recent review by Martin et al further describes models to establish maintenance treatment on discharge; including the Substance Abuse Services and Referral to Treatment model, bridge model, and emergency department-bridge model. 139 These models may provide useful guidance in implementation and logistical details to support health systems in better addressing OUD in their communities.…”

Section: Special Articlementioning

confidence: 99%

Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel

Kohan

Potru

Barreveld

et al. 2021

Reg Anesth Pain Med

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BackgroundThe past two decades have witnessed an epidemic of opioid use disorder (OUD) in the USA, resulting in catastrophic loss of life secondary to opioid overdoses. Medication treatment of opioid use disorder (MOUD) is effective, yet barriers to care continue to result in a large proportion of untreated individuals. Optimal analgesia can be obtained in patients with MOUD within the perioperative period. Anesthesiologists and pain physicians can recommend and consider initiating MOUD in patients with suspected OUD at the point of care; this can serve as a bridge to comprehensive treatment and ultimately save lives.MethodsThe Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, American Society of Anesthesiologists, American Academy of Pain Medicine, American Society of Addiction Medicine and American Society of Health System Pharmacists approved the creation of a Multisociety Working Group on Opioid Use Disorder, representing the fields of pain medicine, addiction, and pharmacy health sciences. An extensive literature search was performed by members of the working group. Multiple study types were included and reviewed for quality. A modified Delphi process was used to assess the literature and expert opinion for each topic, with 100% consensus being achieved on the statements and each recommendation. The consensus statements were then graded by the committee members using the United States Preventive Services Task Force grading of evidence guidelines. In addition to the consensus recommendations, a narrative overview of buprenorphine, including pharmacology and legal statutes, was performed.ResultsTwo core topics were identified for the development of recommendations with >75% consensus as the goal for consensus; however, the working group achieved 100% consensus on both topics. Specific topics included (1) providing recommendations to aid physicians in the management of patients receiving buprenorphine for MOUD in the perioperative setting and (2) providing recommendations to aid physicians in the initiation of buprenorphine in patients with suspected OUD in the perioperative setting.ConclusionsTo decrease the risk of OUD recurrence, buprenorphine should not be routinely discontinued in the perioperative setting. Buprenorphine can be initiated in untreated patients with OUD and acute pain in the perioperative setting to decrease the risk of opioid recurrence and death from overdose.

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Beyond Buprenorphine: Models of Follow-up Care for Opioid Use Disorder in the Emergeny Department

Cited by 34 publications

References 16 publications

“It wasn’t here, and now it is. It’s everywhere": fentanyl’s rising presence in Oregon’s drug supply

“It wasn’t here, and now it is. It’s everywhere": fentanyl’s rising presence in Oregon’s drug supply

Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department

Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel

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