Post-Overdose Extended-Release Buprenorphine Initiation Facilitated by a Partnership Between Emergency Medical Services and an Outpatient Substance Use Disorder Observation Unit.

Substance use & addiction journal Pub Date : 2024-10-01 Epub Date: 2024-05-12 DOI:10.1177/29767342241249386
Jessica L Taylor, Jacqueline Gott, Karrin Weisenthal, Paige Colicchio, Sophia Dyer, Miriam S Komaromy
{"title":"Post-Overdose Extended-Release Buprenorphine Initiation Facilitated by a Partnership Between Emergency Medical Services and an Outpatient Substance Use Disorder Observation Unit.","authors":"Jessica L Taylor, Jacqueline Gott, Karrin Weisenthal, Paige Colicchio, Sophia Dyer, Miriam S Komaromy","doi":"10.1177/29767342241249386","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>People who experience a nonfatal opioid overdose and receive naloxone are at high risk of subsequent overdose death but experience gaps in access to medications for opioid use disorder. The immediate post-naloxone period offers an opportunity for buprenorphine initiation. Limited data indicate that buprenorphine administration by emergency medical services (EMS) after naloxone overdose reversal is safe and feasible. We describe a case in which a partnership between a low-barrier substance use disorder (SUD) observation unit and EMS allowed for buprenorphine initiation with extended-release injectable buprenorphine after naloxone overdose reversal.</p><p><strong>Case: </strong>A man in his 40's with severe opioid use disorder and numerous prior opioid overdoses experienced overdose in the community. EMS was activated and he was successfully resuscitated with intranasal naloxone, administered by bystanders and EMS. He declined emergency department (ED) transport and consented to transport to a 24/7 SUD observation unit. The patient elected to start buprenorphine due to barriers attending opioid treatment programs daily. His largest barrier was unsheltered homelessness. His severe opioid withdrawal symptoms were successfully treated with 16/4 mg sublingual buprenorphine/naloxone and 300 mg extended-release injectable buprenorphine (XR-buprenorphine), without precipitated withdrawal. Two weeks later, he reported no interval fentanyl use.</p><p><strong>Discussion: </strong>We describe the case of a patient successfully initiated onto XR-buprenorphine in the immediate post-naloxone period via a partnership between an outpatient low-barrier addiction programs and EMS. Such partnerships offer promise in expanding buprenorphine access and medication choice, particularly for the high-risk population of patients who decline ED transport.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":" ","pages":"771-776"},"PeriodicalIF":0.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Substance use & addiction journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/29767342241249386","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/5/12 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: People who experience a nonfatal opioid overdose and receive naloxone are at high risk of subsequent overdose death but experience gaps in access to medications for opioid use disorder. The immediate post-naloxone period offers an opportunity for buprenorphine initiation. Limited data indicate that buprenorphine administration by emergency medical services (EMS) after naloxone overdose reversal is safe and feasible. We describe a case in which a partnership between a low-barrier substance use disorder (SUD) observation unit and EMS allowed for buprenorphine initiation with extended-release injectable buprenorphine after naloxone overdose reversal.

Case: A man in his 40's with severe opioid use disorder and numerous prior opioid overdoses experienced overdose in the community. EMS was activated and he was successfully resuscitated with intranasal naloxone, administered by bystanders and EMS. He declined emergency department (ED) transport and consented to transport to a 24/7 SUD observation unit. The patient elected to start buprenorphine due to barriers attending opioid treatment programs daily. His largest barrier was unsheltered homelessness. His severe opioid withdrawal symptoms were successfully treated with 16/4 mg sublingual buprenorphine/naloxone and 300 mg extended-release injectable buprenorphine (XR-buprenorphine), without precipitated withdrawal. Two weeks later, he reported no interval fentanyl use.

Discussion: We describe the case of a patient successfully initiated onto XR-buprenorphine in the immediate post-naloxone period via a partnership between an outpatient low-barrier addiction programs and EMS. Such partnerships offer promise in expanding buprenorphine access and medication choice, particularly for the high-risk population of patients who decline ED transport.

紧急医疗服务与药物使用障碍门诊观察室之间的合作促进了用药过量后缓释丁丙诺啡的使用。
背景:经历非致命性阿片类药物过量并接受纳洛酮治疗的患者,其后因药物过量而死亡的风险很高,但在获得治疗阿片类药物使用障碍的药物方面却存在差距。纳洛酮使用后的第一时间为丁丙诺啡的使用提供了机会。有限的数据表明,纳洛酮过量逆转后由紧急医疗服务(EMS)给予丁丙诺啡是安全可行的。我们描述了一个病例,在该病例中,低门槛药物使用障碍(SUD)观察单位与急救医疗服务机构合作,在纳洛酮过量逆转后开始使用丁丙诺啡缓释注射剂:一名 40 多岁的男子患有严重的阿片类药物使用障碍,并曾多次因阿片类药物过量而在社区内用药过量。紧急医疗服务启动后,旁观者和紧急医疗服务人员为他注射了鼻内纳洛酮,成功地对他进行了抢救。他拒绝了急诊科(ED)的转运,并同意转运至全天候 SUD 观察室。由于每天参加阿片类药物治疗项目存在障碍,患者选择开始服用丁丙诺啡。他最大的障碍是无家可归。使用 16/4 毫克舌下含服丁丙诺啡/纳洛酮和 300 毫克缓释注射用丁丙诺啡(XR-丁丙诺啡)成功治疗了他的严重阿片类药物戒断症状,没有出现沉淀性戒断。两周后,他报告说没有间断使用芬太尼:我们描述了一例通过门诊低门槛戒毒计划和急救服务之间的合作,成功在纳洛酮注射后立即开始使用 XR 丁丙诺啡的患者。这种合作关系有望扩大丁丙诺啡的使用范围和用药选择,尤其是对于拒绝急诊室转运的高危人群。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信