Opiate Use Disorder in the Emergency Dept

Over 2 million Americans misuse prescription or illicitly obtained opioids, and opioid overdose deaths rose to a record 47,600 in 2017, representing a nearly 600% increase in 18 years. Because patients with opioid use disorder (OUD) are often socioeconomically and functionally marginalized, the primary point of contact with healthcare for many is the emergency department (ED). Emergency clinicians are therefore ideally positioned to address the current opioid addiction and overdose epidemic by preventing the development of OUD, identifying patients affected by OUD, and initiating the most effective treatments and harm-reduction practices.  As the scope of the epidemic has broadened, a crucial shift in therapeutic strategy has occurred: whereas people with OUD were commonly referred to detoxification programs, and the use of medication to treat addiction was largely confined to specialist-run clinics, there is now broad consensus discouraging abstinence-based therapy, which usually results in dangerous relapse, in favor of medication-centered treatment initiated at any point of patient contact.  Most currently practicing emergency clinicians were not trained to initiate medication for addiction treatment (MAT), also known as medication-assisted therapy, med- ications for opioid use disorder (MOUD), opioid agonist treatment (OAT), or opioid substitution treatment. This guideline aims to provide evidence-based recommendations for clinicians in acute care settings managing patients being harmed—or at risk to be harmed—by opioids.