Those who work in emergency departments are on the front lines of the opioid crisis, managing serious and life-threatening issues of opioid overdose and addiction every day. Now, emergency department physicians and other medical professionals have new tools at their disposal. The National Institute on Drug Abuse offers informational resources for ER clinicians who are interested in initiating buprenorphine treatment in emergency departments. What are these resources, and how could they change the ways that opioid overdoses are treated in emergency rooms?
The Situation in Emergency Rooms
While emergency room physicians can often reverse overdoses using the medication naloxone, this medication is not a treatment for substance misuse. It can save lives. However, after someone’s life has been saved by naloxone, emergency room staff need other tools as well, tools that can help people begin to move away from substance misuse altogether and into a future of sobriety in which naloxone will no longer be necessary.
According to the National Institute on Drug Abuse, emergency room physicians have a medication called buprenorphine, which gives people a feeling of stability and manages symptoms without a high. NIDA notes:
“Since 2002, emergency clinicians have been able to administer buprenorphine to help patients manage opioid withdrawal symptoms, but the practice is still new in many emergency department settings.”
However, there are a lot of social processes that need to occur before a patient is given drugs that help manage withdrawal symptoms. How can emergency room doctors work with a patient to help them choose to initiate treatment for substance misuse?
New NIDA Resources Are Available
This is where the new NIDA informational resources come into play. These resources offer up best practices and case-based videos. The videos offer strategies and conversational suggestions that could help physicians treat people with opioid use disorders. These resources are available on the NIDAMED web portal. While they are not official standards or guidelines, they are helpful tools that provide education and tips for health professionals who are treating opioid use disorder in the ER.
Treatment Information for Emergency Room Professionals
How should you treat patients with buprenorphine? These NIDA guidelines provide physicians with more details about how to treat patients. The guidelines include a treatment algorithm to assess for opioid type and last use and information about buprenorphine itself so that physicians better understand how it works and how to assess, treat, discharge and refer patients.
Since treatment should be initiated at a specific time relative to the symptoms and severity of opioid withdrawal, the guidelines provide physicians with a Clinical Opioid Withdrawal Scale (COWS) to determine the stage at which an individual is withdrawing. These guidelines also offer questions for clinicians to ask to assess whether a patient is experiencing an opioid use disorder. These can help clinicians determine the severity of the disorder. For example, they include prompts such as:
- Asking the patient whether they take more of the opioid than they had planned
- Asking whether they have a strong desire to use the opioid
- Asking whether they have given up other activities or are missing other activities due to drug use
When you are working in an emergency room, you have a unique opportunity to work with patients who have experienced a reaction to drugs or are experiencing serious withdrawal symptoms. However, it can be a challenge to begin these conversations.
The NIDA resources give five case study videos that highlight strategies that can be used to motivate patients to start buprenorphine, look into treatment for opioid use disorders and investigate harm reduction. They particularly look at the language that you can use to encourage patients to move toward treatment.
The resources also include heroes in practice videos, which focus on the experiences of emergency room physicians around the country. These videos include various innovations for opioid use disorders in emergency departments nationwide.
For example, Andrew Herring of Highland Hospital speaks about how the hospital works with people who experience substance misuse to give a rapid response to withdrawal symptoms through the use of buprenorphine. After patients have taken buprenorphine, they are better able to make plans to address their long-term treatment.
Understanding the Language Around Opioid Use Disorders
When work in a busy emergency room, it can be difficult to remember what kind of positive, supportive language to use with your patients who experience opioid use disorders. Yet language is very important, and it can be what tips the balance for a patient who is considering seeking addiction treatment. The NIDA resources include a handout on words to use when discussing opioid use disorders. Some of the tips include:
- Using person-first language: focusing on the person, not on the disorder
- Using positive, medically-focused language such as opioid use disorder rather than words that might feel difficult, negative or judgmental — like the word “junkie”
What to Do at Discharge
For emergency room physicians, the relationship with the patient is a shorter-term one. Patients usually begin their treatment in the community and at home. This is a challenge for emergency room professionals who want to see patients find success in their sobriety when those patients need to find longer-term care and support elsewhere. These new guidelines also provide discharge instructions that include a guide for people who are starting buprenorphine at home. These instructions include when patients should begin the medication and what symptoms should be in place when they begin.
At The Recovery Village Palmer Lake, we are here to support your opioid addiction treatment. Connect with the facility to discover how you can improve your substance use disorder and discover a more positive future through sobriety. Contact The Recovery Village Palmer Lake today.
