• Kathy T LeSaint, Kayla J Kendric, and Alexander A Logan.
• Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA; California Poison Control System, San Francisco Division, San Francisco, CA, USA.
• Am J Emerg Med. 2024 Oct 1; 84: 189.e1189.e3189.e1-189.e3.

IntroductionThe ongoing opioid epidemic in the United States has resulted in a substantial increase in overdose deaths and related morbidity and mortality. Given that emergency departments (ED) frequently serve as the initial point of contact for individuals experiencing opioid overdose or seeking treatment for opioid use disorder (OUD), ED clinicians have a pivotal role to play in providing prompt and effective treatment for OUD. While ED clinicians routinely administer sublingual and other transmucosal formulations of buprenorphine, extended-release buprenorphine (BUP-XR) remains underutilized in the ED.Case ReportWe present a case involving the successful administration of BUP-XR in the ED to a patient experiencing spontaneous opioid withdrawal. The patient tolerated test dosing of sublingual buprenorphine (BUP-SL) and subsequently received BUP-XR in the ED. Following this intervention, the patient was referred to the hospital-affiliated substance use disorder outpatient clinic, where he has since demonstrated successful follow-up and retention in treatment.ConclusionOur report adds to the existing limited literature on the administration of BUP-XR in the ED and highlights the need for more comprehensive clinician teaching and guidance, as well as the establishment of in-hospital protocols for BUP-XR. Despite these challenges, our case indicates that initiating BUP-XR could be a viable and effective option for ED patients with OUD.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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