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NewGuidancefortheTreatmentofOpioidUseDisorder(OUD)intheER

Manyofourfamilymemberssufferingwithsubstanceusedisorders(SUDs)enduplookingforcareofonesortoranotherintheirlocalhospitalemergencydepartment.TheycouldarrivethereseekinghelpwiththeirSUD.Theycouldhavecomplicationsfromusing.Theymightbehighandbehavinginadisruptiveordangerouspublicfashionandarriveinthecareofthepolice.Orworstofall,theyarriveinextremis,havingoverdosed.

Ourlovedonesdonotalwaysreceivethecaretheyneed.InthepastdoctorshavehadverylittletrainingintreatingSUDs.Thisischangingnow,butitwilltaketime.ManyemergencydoctorsfeelthatSUDsareoutoftheirfieldofexpertise.TheseattitudesarechangingandjustrecentlytheCanadianAssociationofEmergencyPhysicians(CAEP)releasedtheCAEPPositionStatementonEmergencyDepartmentManagementofOUD.ItclearlysetsoutguidelinesforassessmentandtreatmentofOUD,includingstartingmedicationsforthetreatmentofOUD.

ThePositionStatementoutlinestheexpectedidealtreatmentofpatientswithOUDintheER.Inparticularyourlovedoneshouldbeofferedopioidagonisttherapy,drugsthatsubstitutefortheopioidsthepatientisaddictedto.Thesedrugsarelifesavers;theyallowthepatienttoliveanormalliferatherthanonecentredaroundobtainingdrugstoavoidwithdrawal.ThesafestandeasiesttouseisSuboxone.

InOntario,mostcommunitieshaveaccesstoalocalRapidAccessAddictionMedicine(RAAM)clinic.TheERdoctorcanstartanOUDpatientonSuboxoneandreferthemtothelocalRAAMclinicforfollowup.

Dr.BarbaraWatts

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