Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine

Strayer, Reuben J.; Friedman, Benjamin W.; Haroz, Rachel; Ketcham, Eric; Klein, Lauren R.; LaPietra, Alexis; Motov, Sergey; Taylor, Scott D.; Weiner, Scott G.; Nelson, Lewis S.

doi:10.1016/j.jemermed.2023.01.010

Cited by 13 publications

(9 citation statements)

References 204 publications

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“…This is not a novel ask of critical care providers, who routinely tailor ionopressors, sedatives, and a myriad of other treatments to the unique circumstances of their patients, relying on available guidelines and evidence, even if incomplete. We direct providers to recent practice guidelines applicable to the management of alcohol withdrawal [69,70 ▪ ,71 ▪ ], opioid withdrawal and agonist treatment [72,73 ▪ ], and pain and delirium [74]. Unfortunately, no guidelines exist for management of stimulant withdrawal [75 ▪ ].…”

Section: Substance Withdrawal Pain Delirium and Preventing Overdosementioning

confidence: 99%

Critical care for patients with substance use disorders

Steel,

Bhatraju,

Hills-Dunlap

2023

Current Opinion in Critical Care

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Purpose of review To examine the impact of substance use disorders (SUDs) on critical illness and the role of critical care providers in treating SUDs. We discuss emerging evidence supporting hospital-based addiction treatment and highlight the clinical and research innovations needed to elevate the standards of care for patients with SUDs in the intensive care unit (ICU) amidst staggering individual and public health consequences. Recent findings Despite the rapid increase of SUDs in recent years, with growing implications for critical care, dedicated studies focused on ICU patients with SUDs remain scant. Available data demonstrate SUDs are major risk factors for the development and severity of critical illness and are associated with poor outcomes. ICU patients with SUDs experience mutually reinforcing effects of substance withdrawal and pain, which amplify risks and consequences of delirium, and complicate management of comorbid conditions. Hospital-based addiction treatment can dramatically improve the health outcomes of hospitalized patients with SUDs and should begin in the ICU. Summary SUDs have a significant impact on critical illness and post-ICU outcomes. High-quality cohort and treatment studies designed specifically for ICU patients with SUDs are needed to define best practices and improve health outcomes in this vulnerable population.

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Section: Substance Withdrawal Pain Delirium and Preventing Overdosementioning

confidence: 99%

Critical care for patients with substance use disorders

Steel,

Bhatraju,

Hills-Dunlap

2023

Current Opinion in Critical Care

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“…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:…”

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confidence: 99%

“…4 A number of other medications, including gabapentin and topiramate, have demonstrated modest treatment benefit, 3 though the strongest efficacy data are for naltrexone and acamprosate, which are considered first-line agents. 3,4 Emerging evidence suggests mAUD initiation in the ED is feasible 5,6 and may be associated with improved patient outcomes, including reduced alcohol consumption and higher quality of life. 5 The American Academy of Emergency Medicine recommends considering mAUD in all willing patients.…”

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confidence: 99%

“…5 The American Academy of Emergency Medicine recommends considering mAUD in all willing patients. 3 However, few EDs have established screening and intervention protocols for AUD. 7 Moreover, little research has been done to characterize current prescribing patterns in the ED setting.…”

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confidence: 99%

“…12 However, though ED-specific evidence is limited, literature supports mAUD in other settings, 4 and the overall risk of harm associated with first-line mAUD, when appropriately prescribed, is low. 3 The recent ED guidelines published by Strayer and colleagues, 3 therefore, favor initiation of mAUD.…”

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confidence: 99%

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

De Monnin,

Terian,

Yeary

et al. 2023

Academic Emergency Medicine

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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:

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Medications for alcohol‐use disorder and follow‐up after hospitalization for alcohol withdrawal: A multicenter study

Allaudeen,

Akwe,

Arundel

et al. 2024

Journal of Hospital Medicine

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BackgroundAlcohol withdrawal is a common reason for admission to acute care hospitals. Prescription of medications for alcohol‐use disorder (AUD) and close outpatient follow‐up are commonly recommended, but few studies report their effects on postdischarge outcomes.ObjectivesThe objective of this study is to evaluate the effects of medications for AUD and follow‐up appointments on readmission and abstinence.MethodsThis retrospective cohort study evaluated veterans admitted for alcohol withdrawal to medical services at 19 Veteran Health Administration hospitals between October 1, 2018 and September 30, 2019. Factors associated with all‐cause 30‐day readmission and 6‐month abstinence were examined using logistic regression.ResultsOf the 594 patients included in this study, 296 (50.7%) were prescribed medications for AUD at discharge and 459 (78.5%) were discharged with follow‐up appointments, including 251 (42.8%) with a substance‐use clinic appointment, 191 (32.9%) with a substance‐use program appointment, and 73 (12.5%) discharged to a residential program. All‐cause 30‐day readmission occurred for 150 patients (25.5%) and 103 (17.8%) remained abstinent at 6 months. Medications for AUD and outpatient discharge appointments were not associated with readmission or abstinence. Discharge to residential treatment program was associated with reduced 30‐day readmission (adjusted odds ratio [AOR]: 0.39, 95% confidence interval [95% CI]: 0.18–0.82) and improved abstinence (AOR: 2.50, 95% CI: 1.33–4.73).ConclusionsReadmission and return to heavy drinking are common for patients discharged for alcohol withdrawal. Medications for AUD were not associated with improved outcomes. The only intervention at the time of discharge that improved outcomes was discharge to residential treatment program, which was associated with decreased readmission and improved abstinence.

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Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine

Cited by 13 publications

References 204 publications

Critical care for patients with substance use disorders

Critical care for patients with substance use disorders

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

Medications for alcohol‐use disorder and follow‐up after hospitalization for alcohol withdrawal: A multicenter study

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