Over 2.1 million people in the United States have an opioid use disorder (OUD) and emergency physicians (EPs) are on the front lines of fighting this rapidly escalating epidemic. Yale researchers, Gail D’Onofrio, M.S., M.D, and Kathryn Hawk, M.D, M.P.H., along with Ryan McCormack, M.D., Assistant Professor at the Ronald O. Perelman Department of Emergency Medicine, recently published a groundbreaking article in The New England Journal of Medicine focusing on the importance of engaging patients with OUD in opioid-agonist treatment. The article, “Emergency Departments—A 24/7/365 Option for Combating the Opioid Crisis” (https://www.nejm.org/doi/pdf/10.1056/NEJMp1811988?articleTools) highlights the success of medication-based therapies, in particular buprenorphine.
The authors emphasize that research shows that more than 90 percent of individuals who go through detoxification and attempt abstinence will relapse within six months. Opioids rewire the brain, causing intense cravings that are often impossible to resist. Rather than detox and abstinence, which do little to blunt the craving or undo the remodeling in the brain, Yale experts advocate medication-based therapy. Striving to consistently and effectively deliver evidence-based treatment for OUD — by thinking of the ED as an integral part of the response to the opioid crisis and the healthcare system as a whole — could help change the trajectory of the epidemic.
“Substance use disorder is a huge public health problem,” says D’Onofrio. “We are hopeful that articles, such as this one, will motivate more physicians, in both rural and urban emergency departments, to initiate innovative harm reduction and treatment strategies, receive training for prescribing buprenorphine, and begin engaging patients with OUD in opioid-agonist treatment on a wide scale.”