Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department

Berg, Melody L.; Idrees, Umbreen; Ding, Ru; Nesbit, Suzanne; Liang, Horace; McCarthy, Melissa L.

doi:10.1016/j.drugalcdep.2006.06.014

Cited by 26 publications

(18 citation statements)

References 10 publications

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“…Like other studies conducted in outpatient (Alford et al, 2011; Fiellin et al, 2008; Kakko et al, 2003; Mattick et al, 2014; Soyka, Zingg, Koller, & Kuefner, 2008) and emergency department (Berg et al, 2007; D'Onofrio et al, 2015) settings, our study supports buprenorphine induction as a means of initially engaging patients in treatment. Our findings also uphold the efficacy of the medication itself—our participants were significantly less likely to inject opiates on days they used buprenorphine.…”

Section: Discussionsupporting

confidence: 82%

Buprenorphine Initiation and Linkage to Outpatient Buprenorphine do not Reduce Frequency of Injection Opiate Use Following Hospitalization

Cushman

Liebschutz

Anderson

et al. 2016

Journal of Substance Abuse Treatment

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Background Buprenorphine has established effectiveness for outpatient treatment of opioid use disorder. Our previously published STOP (Suboxone Transition to Opiate Program) trial showed that buprenorphine induction, stabilization, and linkage to outpatient treatment in opioid-dependent inpatients (injection and non-injection drug users) decreased illicit opioid use over 6 months. The present study was a planned subgroup analysis of injection opiate users from STOP. Objective To determine if inpatient buprenorphine initiation and linkage to outpatient buprenorphine reduce injection opiate users' frequency of injection opiate use (IOU). Methods Inpatient injection opiate users at a safety-net hospital were randomized to buprenorphine linkage (induction, stabilization, bridge prescription, and facilitated referral to outpatient treatment) or detoxification (5-day inpatient buprenorphine taper). Conditional fixed-effects Poisson regression was used to estimate the effects of intervention on 30-day (self-report) at 1, 3, and 6 months, measured using 30-day timeline follow-back. The secondary outcome was linkage effectiveness, measured as % presenting to initial outpatient buprenorphine visits after hospital discharge. Results Analysis was limited to persons (n = 62 randomized to detoxification and n = 51 to linkage) with baseline IOU. There were no significant differences in age, ethnicity, or baseline IOU frequency. At follow-up, linkage patients (70.6%) were significantly more likely (p < 0.001) to present to initial buprenorphine visits than detoxification patients (9.7%). However, there was no significant between group difference in the rate of IOU at 1-(IRR = 0.73, p = 0.32), 3- (IRR = 1.20, p = 0.54), or 6-month (IRR = 0.73, p = 0.23) follow-ups. Using person–day analysis, participants self-reported IOU on 5.8% of follow-up days in which they used prescription buprenorphine and 37.5% of non-buprenorphine days. Using a generalized estimating equation, the estimated odds of IOU was 4.57 times higher (p < 0.001) on non-buprenorphine days. Conclusions Despite STOP's success in linking patients who inject opiates to outpatient buprenorphine, the intervention did not significantly decrease their IOU frequency. Injection opiate users will require a more intensive protocol to sustain outpatient buprenorphine treatment and decrease injection with its attendant risks.

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Section: Discussionsupporting

confidence: 82%

Buprenorphine Initiation and Linkage to Outpatient Buprenorphine do not Reduce Frequency of Injection Opiate Use Following Hospitalization

Cushman

Liebschutz

Anderson

et al. 2016

Journal of Substance Abuse Treatment

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“…Emergency department–initiated buprenorphine is feasible based on the results of our study, a previous report, 27 and the published research supporting the use of unobserved buprenorphine induction. 17,39 Emergency department clinicians who are interested in providing this treatment should work to identify a network of community-based treatment services for follow-up care.…”

Section: Discussionsupporting

confidence: 55%

“…An earlier observational study helped establish the feasibility of ED-initiated buprenorphine, yet there was no follow-up comparing alternative referral options or evaluating buprenorphine’s effect on treatment engagement, drug use, or addiction treatment service use. 27 Few studies have examined the efficacy of SBIRT for drug use. 9,10,28,29 Recent studies in primary care and ED settings 11-13 addressing a broad spectrum of drug type and intensity of drug use found no benefit to SBIRT.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence

D’Onofrio

O’Connor

Pantalon

et al. 2015

JAMA

718

590

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“…After baseline nociceptive testing, morphine (Sigma Chemical, St. Louis, MO) was subcutaneously administered to mice 10 mg/kg twice per day on day1, 20 mg/kg twice per day on days 2–3 and 40 mg/kg twice per day on day 4 in 50–100 μl volumes of 0.9% NaCl similar to our previous protocols for OIH and tolerance 5, 26–29 .…”

Section: Methodsmentioning

confidence: 99%

Epigenetic Regulation of Opioid-Induced Hyperalgesia, Dependence, and Tolerance in Mice

Liang

Clark

2013

The Journal of Pain

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Repeated administration of opioids such as morphine induces persistent behavioral changes including opioid-induced hyperalgesia (OIH), tolerance and physical dependence. In the current work we explored how the balance of histone acetyltransferase (HAT) vs. histone deacetylase (HDAC) might regulate these morphine-induced changes. Nociceptive thresholds, analgesia and physical dependence were assessed during and for a period of several weeks after morphine exposure. To probe the roles of histone acetylation, the HAT inhibitor curcumin or a selective HDAC inhibitor suberoylanilide hydroxamic acid (SAHA) was administered daily to groups of animals. Histone acetylation in spinal cord was assessed by Western blotting and immunohistochemistry. Concurrent administration of cucumin with morphine for 4 days significantly reduced development of opioid-induce mechanical allodynia, thermal hyperalgesia, tolerance and physical dependence. Conversely, the HDAC inhibitor SAHA enhanced these responses. Interestingly, SAHA treatment after the termination of opioid administration sustained these behavioral changes for at least 4 weeks. Histone H3 acetylation in the dorsal horn of the spinal cord was increased after chronic morphine treatment, but H4 acetylation was unchanged. Moreover, we observed a decrease in HDAC activity in the spinal cords of morphine treated mice while overall HAT activity was unchanged suggesting a shift towards a state of enhanced histone acetylation.

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Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department

Cited by 26 publications

References 10 publications

Buprenorphine Initiation and Linkage to Outpatient Buprenorphine do not Reduce Frequency of Injection Opiate Use Following Hospitalization

Buprenorphine Initiation and Linkage to Outpatient Buprenorphine do not Reduce Frequency of Injection Opiate Use Following Hospitalization

Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence

Epigenetic Regulation of Opioid-Induced Hyperalgesia, Dependence, and Tolerance in Mice

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