We discussed Medicated Assisted Treatment for opioid use disorder (OUD), focusing on buprenorphine initiated MAT from the ED. In the United States, providers must obtain a DEA X waiver in order to prescribe buprenorphine for OUD For $199, physicians can take a fully online training course, advanced practitioners require additional training.
Protocol specifics vary by institution. Below is an example of a protocol. The clinical opiate withdrawal scale (COWS) can be found on MDCalc. Yale’s protocol, along with extensive resources for MAT from the ED can be found here. Washington ACEP also has online resources .
Check out our sponsor for this show, Figure 1, a free open access application for providers using images and cases.
References:
- Berg ML, Idrees U, Ding R, Nesbit SA, Liang HK, and McCarthy ML. Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department. Drug Alcohol Depend. 2007;86(2-3):239-44. doi:10.1016/j.drugalcdep.2006.06.014.
- Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;(2):CD00220
- Pierce M, Bird SM, Hickman M, Marsden J, Dunn G, Jones A, and Millar T. Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction. 2016;111(2):298-308. doi:10.1111/add.13193.
- Clark RE, Samnaliev M, Baxter JD, and Leung GY. The evidence doesn’t justify steps by state Medicaid programs to restrict opioid addiction treatment with buprenorphine. Health Aff (Millwood). 2011;30(8):1425-33. doi:10.1377/hlthaff.2010.0532
- Martin SA, Chiodo LM, Bosse JD, Wilson A. The Next Stage of buprenorphine Care for Opioid Use disorder. Annal of Internal Medicine