The management of alcohol use disorder in the emergency department, is it time for version 2.0?

Furlong, Kayla; Lang, Eddy

doi:10.1007/s43678-023-00466-6

Cited by 1 publication

(2 citation statements)

References 9 publications

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“…16 As a low-barrier and crucial part of the social safety net, the ED is uniquely situated to address inequities in access to MAT for patients with AUD, by offering these medicines as part of evidence-based care guidelines. 6,21,22…”

Section: Recommendations Box (Continued)mentioning

confidence: 99%

“…Data from the U.S. Veterans Health Administration shows higher use of MAT for AUD than in the general population (5.1%), and that Black American patients are less likely to be prescribed approved medications than Whites or Hispanics 16 . As a low‐barrier and crucial part of the social safety net, the ED is uniquely situated to address inequities in access to MAT for patients with AUD, by offering these medicines as part of evidence‐based care guidelines 6,21,22 …”

Section: Introductionmentioning

confidence: 99%

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

Borgundvaag,

Bellolio,

Miles

et al. 2024

Academic Emergency Medicine

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The fourth Society for Academic Emergency Medicine (SAEM) Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE‐4) is on the topic of the emergency department (ED) management of nonopioid use disorders and focuses on alcohol withdrawal syndrome (AWS), alcohol use disorder (AUD), and cannabinoid hyperemesis syndrome (CHS). The SAEM GRACE‐4 Writing Team, composed of emergency physicians and experts in addiction medicine and patients with lived experience, applied the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding six priority questions for adult ED patients with AWS, AUD, and CHS. The SAEM GRACE‐4 Writing Team reached the following recommendations: (1) in adult ED patients (over the age of 18) with moderate to severe AWS who are being admitted to hospital, we suggest using phenobarbital in addition to benzodiazepines compared to using benzodiazepines alone [low to very low certainty of evidence]; (2) in adult ED patients (over the age of 18) with AUD who desire alcohol cessation, we suggest a prescription for one anticraving medication [very low certainty of evidence]; (2a) in adult ED patients (over the age of 18) with AUD, we suggest naltrexone (compared to no prescription) to prevent return to heavy drinking [low certainty of evidence]; (2b) in adult ED patients (over the age of 18) with AUD and contraindications to naltrexone, we suggest acamprosate (compared to no prescription) to prevent return to heavy drinking and/or to reduce heavy drinking [low certainty of evidence]; (2c) in adult ED patients (over the age of 18) with AUD, we suggest gabapentin (compared to no prescription) for the management of AUD to reduce heavy drinking days and improve alcohol withdrawal symptoms [very low certainty of evidence]; (3a) in adult ED patients (over the age of 18) presenting to the ED with CHS we suggest the use of haloperidol or droperidol (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence]; and (3b) in adult ED patients (over the age of 18) presenting to the ED with CHS, we also suggest offering the use of topical capsaicin (in addition to usual care/serotonin antagonists, e.g., ondansetron) to help with symptom management [very low certainty of evidence].

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