Shifting Tides: Changing the Paradigm of Treating Opioid Use Disorder by Updating Resident Education By Corey Hazekamp, MD, MS; Dana Sacco, MD, MS; and Bernard Chang MD, PhD
SAEM PULSE | NOVEMBER-DECEMBER 2022
This article highlights work from the 2022 NIDA Mentor-Facilitated Training Award, supported by the National Institute on Drug Abuse (NIDA) from the National Institutes of Health (NIH) and sponsored by the SAEM Foundation
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Emergency medicine has long been the front line of patient care for a diverse range of acute and chronic conditions and the clinical milieu where providers can support some of the most vulnerable patients in health care. In the face of the recent opioid epidemic striking our health care system, Emergency departments (ED) have faced increasing numbers of patient with behavioral health concerns and substance use disorder complications. At the onset of my career as an emergency medicine provider, treating patients with opioid use disorder (OUD) in the ED was a humbling experience that inspired me to learn more. However, I quickly encountered
the challenges of utilizing life-saving medications for opioid use disorder (MOUD) in the ED, specifically how to initiate buprenorphine. I soon learned of the NIDA MentorFacilitated Training Award, supported by the National Institute on Drug Abuse (NIDA) from the National Institutes of Health (NIH) and sponsored by SAEM Foundation. My plan was to learn how to overcome barriers to EDinitiated buprenorphine as a resident and disseminate information to other residents interested in learning how to counteract the ongoing opioid epidemic. The result of the project that I proposed, “Shifting Tides: Changing the Paradigm of Treating Opioid Use Disorder by Updating Resident Education,” is a framework we conceptualize as “The 3B’s of Buprenorphine: Basics, Barriers and Beyond the ED.” This framework was created with the intent of helping to better educate residents, as well
as other ED providers, about how to successfully initiate buprenorphine treatment in the ED. In our framework, the Basic reason to offer buprenorphine to patients with OUD in the ED is that it decreases mortality. A randomized control trial showed that patients who are initiated on buprenorphine in the ED had increased retention in treatment and decreased self-reported opioid use. When a patient comes to the ED in opioid withdrawal, if untreated, they are more likely to return to opioid use upon discharge, increasing their risk of overdose and possibly death. Furthermore, there are clinical benefits to using buprenorphine in the ED. Compared to methadone, buprenorphine has less of a risk of apnea and QTc prolongation. The Barriers addressed in our framework include (1) learning how and when to initiate buprenorphine in the
