• Kathy T LeSaint, Brent Klapthor, Ralph C Wang, and Curtis Geier.
• University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.
• West J Emerg Med. 2020 Aug 24; 21 (5): 1175-1181.

IntroductionEmergency care providers routinely treat patients with acute presentations and sequelae of opioid use disorder. An emergency physician and pharmacist implemented a protocol using buprenorphine for the treatment of patients with opioid withdrawal at an academic, Level I trauma center. We describe our experience regarding buprenorphine implementation in the emergency department (ED), characteristics of patients who received buprenorphine, and rates of outpatient follow-up.MethodsWe conducted a retrospective chart review of all patients in the ED for whom buprenorphine was administered to treat opioid withdrawal during an 18-month period from January 30, 2017-July 31, 2018. Data extraction of a priori-defined variables was recorded. We used descriptive statistics to characterize the cohort of patients.ResultsA total of 77 patients were included for analysis. Thirty-three patients (43%) who received buprenorphine did not present with the chief complaint of opioid withdrawal. Most patients (74%) who received buprenorphine last used heroin, and presented in moderate opioid withdrawal. One case of precipitated withdrawal occurred after buprenorphine administration. Twenty-three (30%) patients received outpatient follow-up.ConclusionsThis study underscores the safety of ED-initiated buprenorphine and that buprenorphine administration in the ED is feasible and effective.

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