Episode 161.0 – Opioid Epidemic
A look at the opioid epidemic and what ED providers can do to combat this formidable foe.
Show Notes
- Consider alternatives to opiates for acute pain
- NSAIDs
- Subdissociative ketamine
- Nerve blocks
- Curb misuse and diversion through prescribing a short supply and perform I-STOP checks
- Narcan is not just for acute overdose treatment by EMS or within the ED anymore
- We can equip patients, family members and friends with Narcan kits prior to discharge
- In New York state, can prescribe Narcan to patients with near fatal overdoses or who screen positive for an opioid use disorder
- Intranasal formulation is cheaper and more commonly prescribed than IM
- Buprenorphine induction can be done in the ED for patients in active withdrawal, as calculated by the COWS score.
- MDcalc calculator: https://www.mdcalc.com/cows-score-opiate-withdrawal
- Providers do not need an X-waiver to give a dose of Buprenorphine in the ED for 3 days
- Home induction can be considered for patients not actively withdrawing but would like to enter medication assisted treatment
- Some considerations:
- Contraindicated in patients with severe liver dysfunction and with hypersensitivity reaction to drug
- Oversedation can occur with concurrent use of benzodiazepines and alcohol
- Will precipitate withdrawal if concurrently using full opioid agonists
- Longitudinal care has to be established for patients started on Buprenorphine
- Some considerations:
