Ever wonder why no one questions your opioid prescriptions, but when it comes to prescribing opioid withdrawal therapy there are miles of red tape? With legislative relief in sight, it's time to learn more about how to treat patients with substance use disorder. Guests Reuben Strayer and Lucinda Lai discuss when and how to treat SUD-related conditions in the emergency department and share details about a new curriculum developed with a grant from SAMHSA. 

Substance Use Disorder: Say Goodbye to the X-waiver

Overview
Ever wonder why no one questions your opioid prescriptions but when it comes to prescribing opioid withdrawal therapy there are miles of red tape?

Come take a deep dive into substance use disorder (SUD) from the perspectives of an ED resident and attending. One is developing a curriculum on SUD to be used in EM programs across the country; the other is a champion of the deregulation of buprenorphine and has developed a clinic for those who suffer from Opioid Use Disorder.

Key Points

1. Substance use disorder (SUD) is an epidemic, causing hundreds of thousands of deaths every year in our country.
2. SUD encompasses both legal, and illegals substances and includes alcohol, tobacco, opioids, benzos, and stimulants.
3. In addition to ongoing stigmatization, there are many legislative barriers to prescribing withdrawal therapy, however, deregulation is actively being pursued.
4. The most common medications for opioid use disorder are methadone and buprenorphine (AKA suboxone), of which buprenorphine is within the ED physician’s purview.

Resources and References

1. Shulman M, Wai JM, Nunes EV. Buprenorphine Treatment for Opioid Use Disorder: An Overview. CNS Drugs. 2019;33:567–580. 
2. Haffajee RL, Lin LA, Bohnert ASB, Goldstick JE. Characteristics of US Counties With High Opioid Overdose Mortality and Low Capacity to Deliver Medications for Opioid Use Disorder. JAMA Netw Open. 2019 Jun 5;2(6):e196373. doi: 10.1001/jamanetworkopen.2019.6373. PMID: 31251376; PMCID: PMC6604101.
3. SAMHSA. Practitioner Training. 
4. Lai L. Training the Front Line: Substance Use Disorder Education for EM Residents. EM Resident. 2020;48(4):38-39.
5. Strayer R, Cisewski D. Buprenorphine Initiation in the Emergency Department. EMRA Pain Management Guide. Available in MobilEM.