Skip to Main Content
ED-Initiated Buprenorphine
YSM Home

INFORMATION FOR

Motivating Patient Videos

The following videos shows different situations and approaches to screening, intervening, treating and managing these patients in emergency departments. Topics include:

  • Conversation tools and strategies
  • Opioid use disorder & withdrawal assessments
  • Treatment for opioid use disorder
  • Harm-reduction strategies

Use the information in these videos to support your patients with opioid use disorder.

  • Opioid Overdose: ED-Initiated Buprenorphine

    • Discharge from a controlled environment, such as an abstinence-based, detoxification program, or incarceration is a major risk factor for overdose
    • Addressing stigma
      • Treatment is not about will power
      • Relapse is not a moral failing
      • Normalizing lapses
    • Buprenorphine is an effective medication for
      • Moderate to Severe Opioid Use Disorder
      • Withdrawal symptoms in the ED; Offering treatment and evaluating patient’s comfort will allow for more meaningful discussion
    • How to initiate buprenorphine in the ED:
      • Review urine testing
      • Review patient’s level of withdrawal: Clinical Opioid Withdrawal Scale (COWS)
      • Ask about use of long acting opioids
      • Administer first dose if COWS score > 8
      • Assessing response to buprenorphine
      • Obtaining liver function tests
    • Use of a psychosocial intervention to motivate patients to accept treatment
      • Use of the readiness ruler to start the conversation regarding the patient’s reasons to change
      • Reducing patient guilt and defensiveness around overdose
    • Harm reduction, Overdose Education and Naloxone Distribution Prevention (OEND)
    Watch the video

  • Seeking Treatment for Opioid Use Disorder

    • Multiple attempts at treatment are often necessary and there is always hope for change
    • Recognizing signs and symptoms of opioid withdrawal
    • Initiating buprenorphine in the ED
      • Urine testing positive for opioids
      • Assessing withdrawal with the Clinical Opioid Withdrawal Scale (COWS)
      • Obtaining liver function tests
      • Administering the first dose of buprenorphine
      • Referral to ongoing opioid agonist maintenance treatment
    • Harm reduction strategies, Overdose Education and Naloxone Distribution (OEND)
    Watch the video

  • Opioid Overdose: Harm Reduction

    • Response to patient refusing treatment, wanting to leave the ED
      • Use of reflective listening
      • Asking non-threatening open-ended questions
      • Stressing patient autonomy (i.e. freedom-of-choice)
      • Use of the 4 steps of the Brief Negotiation Interview (Permission, Feedback, Enhancing Motivation with Readiness Ruler, and Offering Advice and Negotiating a Plan)
      • Addressing the patient’s fatalistic and stigmatizing attitudes
    • Introducing Harm Reduction Strategies
      • Addressing the overdose risk with co-use of benzodiazepines and opioids
      • Avoid using alone
      • Overdose Education and Naloxone Distribution (OEND)
    Watch the video

  • Adolescent Presenting with Opioid Overdose: Assessment, Intervention and Referral

    Watch the video

  • Prescription Opioid Withdrawal Symptoms: Assessment, Treatment and Referral

    • Assessing an ED patient’s use of prescription opioids after surgery: Physical Dependence versus Opioid Use Disorder
    • Use of the Structured Clinical Interview for the DSM-5 (SCID) diagnosis of Opioid Use Disorder
    • Describing effective use of buprenorphine for moderate to severe opioid use disorder
    • Initiating ED buprenorphine for opioid withdrawal
    • Referral to Addiction Medicine specialist
    Watch the video

  • Adolescent: Continued discussion regarding alcohol use

    • This video elaborates on quantifying alcohol consumption and performing a brief intervention
    Watch the video