A recent survey showed that emergency department doctors aren’t ready to prescribe buprenorphine to patients with opioid use disorder, even though the number of patients visiting emergency departments due to opioid overdoses is increasing. Medications like buprenorphine can help, but doctors are reluctant to prescribe it due to a lack of support. 

Let’s take a look at how medications like buprenorphine help people experiencing opioid addiction, the barriers doctors are facing when it comes to prescribing it in an emergency setting, and options for medication-assisted treatment. 

Medications and Opioid Use Disorder

Opioid addiction can be difficult to overcome without help. Withdrawal causes physical and psychological symptoms, including intense cravings, muscle cramps, diarrhea, and anxiety. Medications can help ease withdrawal symptoms, making it easier for those experiencing addiction to focus on treatment and recovery. 

Three medications are typically used to treat opioid addiction:

  • Methadone: Methadone is an opioid agonist, which means it acts on opioid receptors in the brain, but it does so in a much slower way that doesn’t produce the same euphoric effects that opioids do. It’s distributed in highly supervised settings, and patients typically have to visit a clinic once per day to receive their prescribed dose. Over time, some patients may be able to take methadone at home. As with any medication used to treat opioid addiction, it’s to be used in conjunction with a comprehensive treatment program. 
  • Naltrexone: Naltrexone comes as a pill form and as an injectable, monthly treatment called Vivitrol. It’s an opioid antagonist, which means that it blocks the activation of opioid receptors. 
  • Buprenorphine: Buprenorphine is an opioid partial agonist, which means it binds to opioid receptors, but don’t activate them as strongly as full agonists like methadone. It reduces cravings and withdrawal symptoms. Since it can produce a euphoric effect and impact the respiratory system, it’s often combined with naloxone, to prevent misuse. For example, Suboxone combines buprenorphine and naloxone. 

Why Emergency Doctors Are Reluctant to Prescribe

Emergency room doctors can help their patients by prescribing buprenorphine. It increases the chances of patients entering a treatment program and reduces the chances of being hospitalized in the future. So, why are they reluctant? 

One reason is a lack of clarification from their hospitals around what they can and can’t do. There’s also a lack of training and experience. The article’s authors recommend developing treatment protocols and training more emergency room staff around those protocols. Hospitals can also develop connections with local treatment programs for referrals. 

The authors also recommend including treatment for opioid use disorder in medical education settings. That would give doctors time to get comfortable with prescribing buprenorphine before they’re in a stressful, overwhelming emergency setting. 

 

Options for Patients

If you or a loved one is experiencing opioid addiction, medications can be an enormous help. You can obtain medication from your primary health care provider. Another option for receiving medication is working with a treatment program. 

Treatment programs offer medication-assisted treatment (MAT). That means that medications are administered in conjunction with a broad recovery program. Treatment programs may start with detox, which is when you stop using opioids. A medically assisted detox can help curb the withdrawal systems and make detox as comfortable as possible. 

Once you’ve detoxed, the next step is treatment. Treatment programs vary. At some, you reside at the treatment facility and focus on treatment full-time. Other treatment programs are outpatient, which means you go to the treatment facility for a few hours per day a few days per week. Outpatient treatment allows you to attend to your day-to-day responsibilities like work, school, or family while still receiving effective treatment. 

In an MAT, you receive medications to help ease cravings and withdrawal symptoms. You also participate in your treatment program, which typically includes education and group support. You learn how to manage the stresses and struggles of life without using opioids. Over time, you wean off the medications under supervision. 

 

MAT at New Life

At New Life Addiction Counseling and Mental Health Services of Pasadena, MD, we work with patients who are addicted to drugs or alcohol. We offer an outpatient opiate detox program and Suboxone and Vivitrol (naltrexone) in our MAT program. After detox is completed, our clients begin our Intensive Outpatient Treatment program, which involves three 3-hour sessions per week. 

We know cost can often be a barrier to treatment. We accept most commercial insurance plans and Maryland Medicaid. If you or a loved one is experiencing opioid addiction, get in touch. We can help. 

References:

https://www.medscape.com/viewarticle/930611

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765700

https://ghr.nlm.nih.gov/condition/opioid-addiction

https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone

https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work

https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone

https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine

https://www.health.harvard.edu/blog/5-myths-about-using-suboxone-to-treat-opiate-addiction-2018032014496