“Recently, one of my patients described surviving a heroin overdose. After being found unconscious by paramedics and administered naloxone, he was transported to an emergency department (ED), where he was observed for several hours and discharged home.
On the way home from the ED, he described feeling terrible; then, remembering he had some heroin tucked away in his sock, he proceeded to use it in the backseat of the car and overdosed again. From the perspective of the medical model of opioid addiction, this type of behavior is neither shocking nor surprising. The fact that it was considered appropriate medical practice to discharge this patient from the ED without initiation of medication treatment for opioid use disorder is.”
Dr. Herring offers strong evidence for low threshold, rapid substance use disorder treatment, urging providers to use buprenorphine after overdose. “It provides both symptomatic relief from withdrawal and subsequent protection from overdose, just as it does with routine initiation during withdrawal from abstinence.” He notes that with tens of thousands of yearly deaths from opioid overdose and the lack of compelling evidence to suggest harm, “it is time for emergency medicine to make initiation of buprenorphine after opioid overdose an expected standard-of-care treatment.”
Read more…
Annals of Emergency Medicine Volume 75, Issue 4, April 2020, Pages 552-553
