bup 101: buprenorphine basics - acmt · 2020. 9. 8. · bup 101: buprenorphine basics jeanmarie...
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Treatment Education for Attending Physicians & Residents
Bup101:BuprenorphineBasics
JeanmariePerrone,MD,FACMTProfessorofEmergencyMedicineDirector,DivisionofMedicalToxicologyUniversityofPennsylvania@JMPerroneMD
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TheEpidemicNow
Fentanyl,carfentanil &designeropioids
ChronicPain
PrescriptionDrugs
HEROIN
DEATHS42,250
CDC 2016
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PhiladelphiaDept.ofPublicHealth,MedicalExaminer’sOffice 2017
OverdoseDeathsinPhiladelphia
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Wiener: ACEP Research Forum 2017
TheBostonGlobe
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Heroinoverdosedeathsduringexpansionofmethadoneandbuprenorphine
Baltimore1995-2009
Schwartz, AJPH, 2013Schwartz, AJPH, 2013
Schwartz AJPH
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D’Onofrio:EmergencyDepartment-InitiatedBuprenorphine/NaloxoneTreatmentforOpioidDependence:ARandomizedClinicalTrial.JAMA2015
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ReferralBriefIntervention
Buprenorphine
D’Onofrio:EDInitiatedBuprenorphine/NaloxoneTreatmentforOpioidDependence:ARandomizedClinicalTrial.JAMA2015
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BarrierstoRxbuprenorphine– It’sjustoneaddictionforanother
– I’mnotpaying$200.00toRxadrugthatPharmacompaniesaremakingmoneyon
– I’mjustnotsurehowtodoit
– Idon’thavethe“xwaiver”trainingsoIdon’tfeelcomfortable
– Whataboutfollowup??
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Whocanorderbuprenorphine?
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72-hourrule
Allowstoadminister(butnotprescribe)narcoticdrugsforthepurposeofrelievingacutewithdrawalsymptomswhilearrangingforthepatient'sreferralfortreatment
Title21,CodeofFederalRegulations,Part1306.07(b)
• Notmorethan1-day'smedicationmaybeadministeredtoapatientatonetime
• PatientmustreturntoEDeachdayfornomorethan72hours
• This72-hourperiodcannotberenewedorextended.
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BuprenorphinePharmacology
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Buprenorphine-Naloxone (Suboxone)
• Buprenorphineisapartialmu-opioidagonist• Naloxoneisacompleteopioidantagonist
SUBLINGUALFILM TABLETS
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ClinicalOpiateWithdrawalScale
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ClinicalOpiateWithdrawalScale
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Buprenorphineadministration
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Buprenorphine
Adverseevents==Precipitatedwithdrawal(worseningwithdrawalsymptoms)
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WarmHandoff
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WarmHandoff
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Summary
• Buprenorphineisanevidencebasedtx thatanyphysiciancanorderintheEDtotreatwithdrawalandbridgetofollowup.
• ACOWStoolishelpfultogaugewithdrawalseverityCOWS>8==buprenorphine
• Rxnaloxoneandwarmhandoff