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January 2021

Case Study: A Long Waitlist and Closed Doors Everywhere but the ED

A 38-year-old M is interested in getting help for stimulant and opioid use but the inpatient program he’d wanted to enter is “holding admits due to a COVID19 outbreak,” and there is a two-week wait for either telemedicine or on-site evaluation at the county treatment program in a rural part of the state. After 3 days of trying to “detox at home,” he presents to the Emergency Department because, “I didn’t know what else to do.” Patient is in florid opioid withdrawal with rhinorrhea, tearing, yawns repeatedly, has vomiting and diarrhea, and is extremely anxious and restless.

ED buprenorphine induction support may be available through a regional Poison Center staffed by Specialists in Poison Information supervised by Medical and Clinical Toxicologists (some Poison Centers have even developed protocols for initiation and linkage). Reaching out to an Addiction Medicine or Medical Toxicology specialist (or consulting if the service exists at your hospital) is also another option for support.

Additional information about X-waiver training and treatment of opioid use disorders can be accessed through the SAMHSA and PCSS websites.

Frequently Asked Questions



Full Case Discussion can be found here:

  1. Edwards FJ, Wicelinski R, Gallagher N, McKinzie A, White R, Domingos A. Treating Opioid Withdrawal With Buprenorphine in a Community Hospital Emergency Department: An Outreach Program. Ann Emerg Med. 2020;75(1):49-56. doi:10.1016/j.annemergmed.2019.08.420
  2. Huhn AS, Hobelmann JG, Oyler GA, Strain EC. Protracted renal clearance of fentanyl in persons with opioid use disorder. Drug Alcohol Depend. 2020;214:108147. doi:10.1016/j.drugalcdep.2020.108147
  3. D'Onofrio G, O'Connor PG, Pantalon MV, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636-1644. doi:10.1001/jama.2015.3474
  4. D'Onofrio G, Chawarski MC, O'Connor PG, et al. Emergency Department-Initiated Buprenorphine for Opioid Dependence with Continuation in Primary Care: Outcomes During and After Intervention. J Gen Intern Med. 2017;32(6):660-666. doi:10.1007/s11606-017-3993-2