Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Am J Emerg Med. 2021 Oct;48:316-322. doi: 10.1016/j.ajem.2021.06.065. Epub 2021 Jul 5.
Opioid abuse and overdose deaths have reached epidemic proportions in the last couple decades. In response to rational prescribing initiatives, utilization of prescription opioids has decreased; however, the number of deaths due to opioid overdoses continues to rise, largely driven by fentanyl analogues in adulterated heroin. Solutions to the opioid crisis must be multifaceted and address underlying opioid addiction. In recent years, buprenorphine has become a cornerstone in the treatment of opioid use disorder (OUD) and initiation of therapy in the emergency department (ED) has become increasingly common. There have also been calls by many organizations to remove the requirement for additional training and X-waiver to prescribe buprenorphine. In April 2021, the Biden Administration eased prescribing restrictions on the drug. These initiatives are expected to increase ED utilization of the buprenorphine. The purpose of this paper is to provide an updated overview of the role and use of buprenorphine in the ED setting so physicians may adapt to the changing practice environment.
This is a narrative review describing the role of buprenorphine in the ED. A PubMed search was conducted using the keywords "opioid epidemic" "buprenorphine," and "medication assisted therapy", and "emergency department". All the articles that contained information on the opioid epidemic, medication assisted therapy, and the biological effects of buprenorphine, that were also relevant to pain management and the ED, were included in the review.
Multiple studies have pointed to the effective use of buprenorphine as a treatment for OUDs in ED patients and are superior to standard care; however, there are various barriers to its use in the ED setting.
Emergency physicians can influence opioid related morbidity and mortality, by familiarizing themselves with the use of buprenorphine to treat opioid withdrawal and addiction, particularly now that prescribing restrictions have been eased. Further ED research is necessary to assess the optimal use of buprenorphine in this care setting.
在过去的几十年里，阿片类药物滥用和过量死亡已达到流行程度。作为对合理处方倡议的回应，处方阿片类药物的使用量有所减少；然而，由于掺假海洛因中的芬太尼类似物，阿片类药物过量死亡人数继续上升。解决阿片类药物危机必须是多方面的，并解决潜在的阿片类药物成瘾问题。近年来，丁丙诺啡已成为治疗阿片类药物使用障碍（OUD）的基石，在急诊科（ED）开始治疗的情况也越来越普遍。许多组织也呼吁取消开具丁丙诺啡的额外培训和 X 豁免要求。2021 年 4 月，拜登政府放宽了对该药物的处方限制。这些举措预计将增加 ED 对丁丙诺啡的使用。本文的目的是提供丁丙诺啡在 ED 环境中的作用和使用的最新概述，以便医生能够适应不断变化的实践环境。
这是一篇叙述性综述，描述了丁丙诺啡在 ED 中的作用。使用关键词“阿片类药物流行”“丁丙诺啡”和“药物辅助治疗”以及“急诊科”在 PubMed 上进行了搜索。所有包含有关阿片类药物流行、药物辅助治疗以及丁丙诺啡的生物学作用的信息，并且与疼痛管理和 ED 相关的文章都包含在综述中。
多项研究指出，丁丙诺啡在 ED 患者的 OUD 治疗中有效，并且优于标准护理；然而，在 ED 环境中使用它存在各种障碍。
急诊医师可以通过熟悉丁丙诺啡在治疗阿片类药物戒断和成瘾方面的使用，来影响与阿片类药物相关的发病率和死亡率，尤其是现在处方限制已经放宽。需要进一步的 ED 研究来评估丁丙诺啡在这种护理环境中的最佳使用。
