Hospital Settings: Addiction Treatment Tools, Training, and Resources

The emergency department is a critical resource for patients suffering substance use disorder, or addiction. These patients are someone's son or daughter, brother or sister, mother or father, friend or colleague. Approaching them and their disease as you would any other patient, using non-stigmatizing language and mannerisms, meeting them where they are, and advocating for their recovery, often helps develop interest in engaging in long-term treatment for their illness. We all recognize the challenges that addiction adds to an ED visit, but framing their illness like that of the dozens of other chronic illnesses we face will lead ourselves and our patients to a better place - Lewis Nelson, MD, FASAM - Emergency Medicine

An estimated 547,543 emergency room visits occurred for all drug-related poisonings in the U.S. in 2015.[i]

Treatment Resources

On-Demand Training

Treatment Resources:

NIDAMED Discipline Spotlight: Emergency Physicians and First Responders
Medication Treatment for Opioid Use Disorder in the Emergency Medicine Setting

A study by the National Institute on Drug Abuse Center for Clinical Trials Network suggests that emergency department (ED)-initiated treatment with buprenorphine-naloxone and referral to treatment for patients who are opioid dependent increases their engagement in formal addiction treatment and reduces their opioid misuse when compared with brief intervention and referral alone (D’Onofrio et al., 2015).
https://www.drugabuse.gov/nidamed-medical-health-professionals/science-to-medicine/medication-treatment-opioid-use-disorder/in-emergency-medicine-setting

 

Medication Treatment for Opioid Use Disorder in the Hospital Setting

Inpatient hospitalization may serve as a reachable moment for initiating and coordinating substance use disorder (SUD) treatment, including medication treatment for opioid use disorder (OUD). Liebschutz and colleagues examined whether patients dependent on opioids, who were hospitalized for other medical conditions and then received buprenorphine induction followed by linkage to buprenorphine treatment, had lower opioid misuse at 6-months compared with those who underwent only detoxification during hospitalization. Their study found that those who were linked to treatment used medication treatment for OUD longer and reported 0 days of opioid misuse more often than those who received only detoxification and were not linked to treatment (Liebschutz et al., 2014).

Another study found that inpatient hospitalization may be an effective time for reaching patients who need treatment, as they realize that substance use has negatively affected their health. The study emphasized the importance of nonjudgmental, caring staff for garnering patient trust; not pressuring patients into treatment; and improved care coordination and timely transition to SUD treatment (Velez, Nicolaidis, Korthuis, & Englander, 2016).
https://www.drugabuse.gov/nidamed-medical-health-professionals/science-to-medicine/medication-treatment-opioid-use-disorder/medication-treatment-opioid-use-disorder-in-inpatient

 

Guideline on Alcohol Withdrawal Management

The ASAM Guideline on Alcohol Withdrawal Management is intended to aid clinicians in their clinical decision making and management of patients experiencing alcohol withdrawal syndrome.

https://www.asam.org/docs/default-source/quality-science/the_asam_clinical_practice_guideline_on_alcohol-1.pdf?sfvrsn=ba255c2_2

 

Buprenorphine use in the Emergency Department Tool

https://www.acep.org/bupe/

 

Addiction Treatment in the Acute Hospital Setting During the COVID-19 Pandemic

To provide guidance related to the delivery of addiction treatment in hospital settings during the COVID-19 pandemic.

https://www.asam.org/Quality-Science/covid-19-coronavirus/hospital_settings

 

ACMT Position Statement: Buprenorphine Administration in the Emergency Department

The position of the American College of Medical Toxicology (ACMT), endorsed by the American Academy of Emergency Medicine (AAEM), American Society of Addiction Medicine (ASAM), and the American College of Emergency Physicians (ACEP)

https://www.acmt.net/_Library/Positions/ACMT_PS_Bup_ED_9_2.pdf

 

Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department (June 2020)

This guideline is intended for physicians working in emergency departments.

ACEP Clinical Policy: Critical Issues in the Prescribing of Opioids for Adults Patients in the ED

 

On-Demand Training Opportunities:

Hospital Based Addiction Medicine Cases & Challenges

This workshop features national thought leaders in hospital-based addiction medicine care who will expertly discuss and describe treatment approaches to challenging addiction medicine cases. The session will describe clinical scenarios that challenge the inpatient medical team and will offer evidence-based approaches, including ways to integrate a diverse addiction medicine workforce into routine hospital-based care. Cases include management of post-operative pain in the setting of OUD, use of illicit substances by hospitalized patients, initiation of medication for opioid use disorder in patients prescribed full opioid agonists, and management of patients requiring prolonged intravenous antibiotics for complications of injection drug use including management of care transitions.

https://elearning.asam.org/products/hospital-based-addiction-medicine-cases-challenges#tab-product_tab_overview

 

The ASAM Alcohol Withdrawal Management Webinar Series - Identification, Diagnosis, and Initial Assessment

The webinar follows the ASAM Alcohol Withdrawal Management Fundamentals webinar, which intends to aid clinicians in their clinical decision making and management of patients experiencing alcohol withdrawal syndrome, as written in The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management.

Signs and symptoms of AWS can escalate quickly and the trajectory of alcohol withdrawal can vary considerably among patients. As the most severe presentations of alcohol withdrawal are life threatening, orienting the initial assessment toward evaluating risk is recommended. The second of its series, this webinar will provide an overview of the assessment recommendations around alcohol withdrawal management and in-depth information on tools and differential diagnosis.

https://elearning.asam.org/products/the-asam-alcohol-withdrawal-management-webinar-series-identification-diagnosis-and-initial-assessment

 

Recent Related Articles

Do Patients Require Emergency Department Interventions After Prehospital Naloxone?

Patients receiving naloxone for suspected opioid overdose in the prehospital setting are typically transported to the emergency department (ED) for further evaluation, regardless of Glasgow Coma Scale (GCS). The objective of our study is to determine whether patients with GCS ≥14 after receiving prehospital naloxone received additional doses of naloxone and medical interventions in the ED compared with those with GCS <14 after prehospital naloxone.

https://journals.lww.com/journaladdictionmedicine/Abstract/2020/06000/Do_Patients_Require_Emergency_Department.8.aspx

 

Nonfatal Opioid Overdoses at an Urban Emergency Department During the COVID-19 Pandemic

Psychosocial consequences related to coronavirus disease 2019 (COVID-19) may place individuals at a heightened likelihood of opioid overdose or relapse. This study compared the numbers of nonfatal, unintentional opioid-related opioid overdoses during the early months of the pandemic to the prior year, at one emergency department. Compared to the previous year, there were a greater number of visits for opioid overdoses and Black patients made up a relatively larger proportion of opioid overdose.

Journal of the American Medical Association >>>

Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report. Published August 31, 2018. Accessed September 24, 2020 from https://www.cdc.gov/ drugoverdose/pdf/pubs/2018- cdc-drug-surveillance-report.pdf