Opioid Overdose: ED-Initiated Buprenorphine

June 03, 2019

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)

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