In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Corey Hazekamp, MD, MS, one of authors of the June 2024 Emergency Medicine Practice article, Managing Emergency Department Patients With Opioid Use Disorder
Current State of Opioid Epidemic
- Overview of overdose deaths and trends.
- Data and statistics about opioid overdose mortality rates.
- Three Waves of Opioid Overdose Deaths in the U.S.
Opioid Classifications and Urine Drug Testing
- Types of opioids: synthetic, semi-synthetic, and natural.
- Urine drug testing limitations and false positives/negatives.
- Practical use and research on co-ingestions
Emergency Medical Services (EMS) and Pre-Hospital Care
- Importance of ABCs in acute opioid overdose cases.
- Naloxone usage trends and an empirical approach.
- Anecdotal insights on changing naloxone administration dosages.
Clinical Management in the Emergency Department
Buprenorphine Initiation
- Protocols for initiating buprenorphine in ED settings.
- Assessment using the Clinical Opiate Withdrawal Scale (COWS).
- Safe dosing procedures for buprenorphine.
Withdrawal and Overdose Care
- Laboratory testing recommendations.
- Capnography and VBG in overdose management.
- The role of end-tidal CO2 monitoring and respirations.
Methadone vs. Buprenorphine Considerations
- Methadone to buprenorphine transition protocols.
- Personal testimonials and clinical experiences in managing overdoses and withdrawal symptoms.
Patient Discharge and Follow-upPreparation of discharge prescriptions.
- Referral to addiction medicine clinics and resources.
- Educating patients on continued treatment and harm reduction.