A look at the opioid epidemic and what ED providers can do to combat this formidable foe. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Opioid_Epidemic.mp3 Download Leave a Comment Tags: Opioid Dependence, Opioid Free ED 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 * SAMHSA’s Buprenorphine practitioner locator site: https://www.samhsa.gov/medication-assisted-treatment/practitioner-program-data/treatment-practitioner-locator * Buprenorphine Induction Pamphlet Read More