ER Practices Key to Helping Those Addicted to Painkillers: Study

Giving patients drug that helps ease withdrawal works better than simple referrals, experts say

By Mary Elizabeth Dallas

Tuesday, April 28, 2015

TUESDAY, April 28, 2015 (HealthDay News) -- A comparison of three treatments for narcotic painkiller addiction found that patients given the medication buprenorphine in the emergency department do better than those given only referrals.

Addiction to prescription narcotic painkillers such as Oxycontin or Vicodin is "a huge public health problem," study first author Dr. Gail D'Onofrio, chair of emergency medicine at Yale School of Medicine in New Haven, Conn., said in a university news release. Drug overdoses account for more deaths each day in the United States than car crashes, she and her colleagues noted.

Although buprenorphine is also a narcotic, at low doses it enables people to discontinue painkiller misuse without experiencing withdrawal symptoms, according to the U.S. Substance Abuse and Mental Health Services Administration. This helps them to engage in treatment.

D'Onofrio's team set out to test the medication's effectiveness in a study of 300 emergency department (ED) patients. The researchers explained that people with narcotic painkiller addiction often seek emergency medical care for overdose or abscesses. Afterwards, they're usually referred to addiction treatment.

For the study, published April 28 in the Journal of the American Medical Association, the investigators divided the patients into three groups. One group received a list of available services, while another got a motivational consultation and referral. A third group received a brief intervention and treatment with buprenorphine that was continued in primary care.

Patients given buprenorphine had the best outcomes and were less likely to need in-patient treatment at a residential facility, the study revealed.

"The patients who received ED-initiated medication and referral for ongoing treatment in primary care were twice as likely as the others to be engaged in treatment 30 days later," D'Onofrio said in the news release. "They were less likely to use illicit opioids of any kind."

The researchers noted their findings underscore previous studies that examined the benefits of buprenorphine for narcotic painkiller addiction.

"Prior research at Yale has demonstrated that buprenorphine treatment is highly effective in primary care, and this study was designed in part to expand the reach of this treatment to this critical ED patient population," Dr. Patrick O'Connor, chief of general internal medicine at Yale School of Medicine, said in the news release.

O'Connor said that linking ED-initiated buprenorphine treatment to ongoing primary care represents an exciting new way of engaging these patients in state-of-the-art care.

The researchers acknowledged the findings need confirmation in other emergency departments, but D'Onofrio was optimistic. "We've offered another expanded use of the [emergency department] to increase access to treatment options for people with this chronic and relapsing condition," she said.

SOURCE: Yale School of Medicine, news release, April 28, 2015

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