Emergency department initiation of pharmacotherapy for alcohol use disorder: A retrospective cohort study

Abstract

Alcohol misuse is a major public health issue in the United States.Alcohol use disorder (AUD), the most severe form of alcohol misuse, carries a prevalence of approximately 8%, and there are over 90,000 yearly alcohol-related deaths in the United States. 1 Persons with AUD utilize emergency departments (EDs) at disproportionately high rates, 1 and thus the ED represents a critical opportunity to provide intervention and treatment to this high-risk population. 2The ED is increasingly recognized as an optimal setting to initiate medications for AUD (mAUD). 3 The U.S. Food and Drug Administration (FDA) has approved naltrexone, acamprosate, and disulfiram for the treatment of moderate or severe AUD, though the data to support their use are largely derived from non-ED, out-How to cite this article:

Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE‐4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department

“…23,24 Recent research suggests that this is also the case in the ED. 25 Randomized controlled trials (RCTs) using a symptom-driven approach (using a validated tool to assess withdrawal severity as part of a standardized protocol with frequent, regular assessments and medication dosages determined by withdrawal severity) to manage AWS demonstrate both faster resolution of symptoms and lower total medication dosages being used. [26][27][28][29] However, there are challenges in implementing symptom-driven approaches to managing AWS in the ED, including little consensus regarding the best tool to measure AWS severity, which protocol to use to guide treatment decisions, and the most effective medications to use.…”

Clinical relevance rather than evidence existence: The SAEMGRACEpragmatism

“…The philosophical underpinnings of the GRACE approach are justified in prioritizing clinical relevance over the quantity of direct evidence 15 . As the first emergency medicine–focused and GRADE‐adherent clinical practice guideline on the topics of alcohol use disorder and cannabinoid hyperemesis syndrome, GRACE‐4 is a beacon of pragmatism for an otherwise murky topic prone to significant practice heterogeneity 16,17 . GRACE‐4 underscores the necessity of addressing pertinent clinical questions, even in the absence of high‐certainty evidence, and thereby fills (or at least illuminates) a knowledge gap.…”