Feasibility of the Utilization of Buprenorphine in the Emergency Room to Treat Clinical Opioid Withdrawal
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology, Other |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 12/15/2018 |
| Start Date: | August 1, 2018 |
| End Date: | August 28, 2018 |
The Utilization of Buprenorphine in the Emergency Room to Treat Clinical Opioid Withdrawal
The investigators are trying to determine whether they can effectively treat patients
suffering from acute opioid withdrawal in the Emergency Department at Virginia Commonwealth
University Health System (VCUHS) and subsequently transfer them to an outpatient addiction
clinic within the existing infrastructure. This will be a descriptive investigation of the
process to reveal areas of success and opportunities for improvement in order to determine
feasibility of the study procedures in preparation for a larger clinical investigation.
suffering from acute opioid withdrawal in the Emergency Department at Virginia Commonwealth
University Health System (VCUHS) and subsequently transfer them to an outpatient addiction
clinic within the existing infrastructure. This will be a descriptive investigation of the
process to reveal areas of success and opportunities for improvement in order to determine
feasibility of the study procedures in preparation for a larger clinical investigation.
Currently, patients in the Emergency Department at VCUHS experiencing opioid withdrawal,
after reversal of opioid intoxication by naloxone, do not receive any direct treatment to
stop the symptoms. They do receive indirect treatment aimed at each specific symptom, such as
an anti-emetic to stop vomiting. The investigators propose directly treating all of the
symptoms with the medication Suboxone, (buprenorphine/naloxone). Buprenorphine is a partial
agonist on the Mu-receptor, which means it will provide less opioid effect than morphine, but
should provide enough to make opioid withdrawal more tolerable. This is very important
because stopping the withdrawal symptoms early will prevent the patient from quickly leaving
and using opioids again, continuing their addiction cycle. The naloxone is included with
buprenorphine as a deterrent to prevent intravenous injection of the drug for abuse. The
investigators believe that if the patient is treated with Suboxone for withdrawal in the
emergency department, and transported to the outpatient addiction treatment center at VCU,
called the MOTIVATE clinic, the investigators can potentially break that cycle and help the
patient work toward recovering. If successful, the investigators hope to improve the quality
of life, prevent further overdose and death in those suffering from this deadly addiction.
Buprenorphine effectively treats the opioid withdrawal state. This has been demonstrated in
many studies during the initial induction period with buprenorphine. Many of these patients
are experiencing opioid withdrawal during this time. The sublingual dose can effectively be
increased to resolve symptoms. According to many protocols and guidelines, acute opioid
withdrawal is the preferred state of the patient when buprenorphine should be started.
after reversal of opioid intoxication by naloxone, do not receive any direct treatment to
stop the symptoms. They do receive indirect treatment aimed at each specific symptom, such as
an anti-emetic to stop vomiting. The investigators propose directly treating all of the
symptoms with the medication Suboxone, (buprenorphine/naloxone). Buprenorphine is a partial
agonist on the Mu-receptor, which means it will provide less opioid effect than morphine, but
should provide enough to make opioid withdrawal more tolerable. This is very important
because stopping the withdrawal symptoms early will prevent the patient from quickly leaving
and using opioids again, continuing their addiction cycle. The naloxone is included with
buprenorphine as a deterrent to prevent intravenous injection of the drug for abuse. The
investigators believe that if the patient is treated with Suboxone for withdrawal in the
emergency department, and transported to the outpatient addiction treatment center at VCU,
called the MOTIVATE clinic, the investigators can potentially break that cycle and help the
patient work toward recovering. If successful, the investigators hope to improve the quality
of life, prevent further overdose and death in those suffering from this deadly addiction.
Buprenorphine effectively treats the opioid withdrawal state. This has been demonstrated in
many studies during the initial induction period with buprenorphine. Many of these patients
are experiencing opioid withdrawal during this time. The sublingual dose can effectively be
increased to resolve symptoms. According to many protocols and guidelines, acute opioid
withdrawal is the preferred state of the patient when buprenorphine should be started.
Inclusion Criteria:
- Opioid overdose only, of any formulation or route, with complete reversal of toxicity
after naloxone by any route.
- RR ≥ 12
- Pulse oximetry > 95%
- GCS 15
- Clinical Opioid Withdrawal Scale (COWS) score ≥ 8
Exclusion Criteria:
- Pregnancy
- Prisoner
- Incomplete reversal of toxicity related to metrics above
- Police custody
- Known allergy to buprenorphine
- Emergent psychiatric condition including active suicidality that requires admission
- Emergent medical condition that requires admission
We found this trial at
1
site
Virginia Commonwealth University Since our founding as a medical school in 1838, Virginia Commonwealth University...
Click here to add this to my saved trials
