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Emergency Department-Administered Buprenorphine Is Safe, Effective

Rates of precipitated withdrawal are less than 1 percent

By Lori Solomon HealthDay Reporter

WEDNESDAY, April 5, 2023 (HealthDay News) — Buprenorphine induction in the emergency department is safe and effective, even for fentanyl use, according to a research letter published online March 30 in JAMA Network Open.

Gail D’Onofrio, M.D., from the Yale School of Medicine in New Haven, Connecticut, and colleagues evaluated the incidence of precipitated withdrawal (PW) as part of an ongoing randomized clinical trial comparing traditional sublingual buprenorphine with CAM2038, a seven-day extended-release injectable form of buprenorphine. The analysis included 1,200 patients seen at 28 emergency departments (June 30, 2020, to Oct. 26, 2022).

The researchers identified nine cases of PW (0.76 percent of the overall sample), and of these, five received sublingual buprenorphine and four received extended-release buprenorphine. There was variance in routes of use, changes in baseline and peak Clinical Opiate Withdrawal Scale scores, and time elapsed from buprenorphine administration to PW, but all patients had urine tests positive for fentanyl. There was a range in time since last use from eight to >24 hours. Among patients experiencing PW, all were discharged after symptoms resolved, with one self-directed discharge. The majority (86 percent) had follow-up rates at seven days after the emergency department visit.

“Continued access to buprenorphine for opioid use disorder treatment is essential given the ongoing overdose crisis,” the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

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