Using Buprenorphine in Clinical Practice
ColoradoMAT provides a practical framework for the use of buprenorphine as an effective, short-term treatment for opioid withdrawal and a bridge to long-term treatment of opioid use disorder. MAT saves lives and the resources below are meant to help ED clinicians care for this vulnerable patient population.
Have a difficult case?
Want help in determining whether to give buprenorphine? Want help in treating precipitated withdrawal? Rocky Mountain Poison Control can help. Call 1-800-222-1222 and specify “ED buprenorphine induction support” to speak with a specialist.
These resources do not set a standard of care, rather they are an educational aid to practice. They were developed by an interdisciplinary team based on published evidence and expert opinion; as the literature and science advance, these best practices may change.
These guides are not a substitute for clinical judgement. Individual providers are responsible for assessing the unique circumstances and needs of each patient. Adherence to this guide will not ensure successful treatment in every situation. This information is intended for health care providers and administrators and is not intended for use by patients or the general population.
Rocky Mountain Poison Center Line
ColoradoMAT has partnered with Rocky Mountain Poison Center to offer 24/7 support for ED clinicians to discuss buprenorphine starts. The Rocky Mountain Poison Center can help you with: identification of opioid withdrawal, dosing of buprenorphine to treat opioid withdrawal, solutions or troubleshooting a plan to bridge patients to outpatient buprenorphine maintenance therapy, treatment of opioid withdrawal in special populations (e.g. pregnancy or pediatrics), treatment of precipitated withdrawal, and treatment of patients with other underlying toxicological conditions.
A special article from the Annal of Internal Medicine, this article reviews research findings in the following 7 areas: location of buprenorphine induction, combining buprenorphine with a benzodiazepine, relapse during buprenorphine treatment, requirements for counseling, uses of drug testing, use of other substances during buprenorphine treatment, and duration of buprenorphine treatment.
Find resources to help build a bridge program in an ED, including protocols, provider education, signage and more.
A tool for opioid use disorders in the ED addressing: buprenorphine and suboxone.
Title 21, Code of Federal Regulations, Part 1306.07(b) allows a practitioner who is not separately registered as a narcotic treatment program or certified as a “waivered DATA 2000 physician” to administer (but not prescribe) narcotic drugs to a patient for the purpose of relieving acute withdrawal symptoms while arranging for the patient’s referral for treatment, under the following conditions: 1) not more than one day’s medication may be administered or given to a patient at one time, 2) this treatment may not be carried out for more than 72 hours and 3) this 72 hour period cannot be renewed or extended.
Under the Drug Addiction Treatment Act of 2000 (DATA 2000), physicians are required to complete an eight-hour training to qualify for a waiver to prescribe and dispense buprenorphine. Find information about the eight-hour buprenorphine waiver (X-waiver) training courses that are required for physicians to prescribe and dispense buprenorphine.
IT MATTTRs2 gives incentives to providers to obtain their DEA X-waiver required to prescribe MAT. The project also delivers Sound Team Training to practices, providing knowledge and tools to adopt a comprehensive MAT program through ongoing practice support and facilitation.
A comprehensive guide to addressing the opioid epidemic in Colorado EDs comprised of clinical recommendations, information and policy guidelines.
The Harm Reduction Action Center (HRAC) has committed itself to serving Colorado’s public health by working to reduce the harms associated with drug use. Since 2002, HRAC has provided direct services that curb the spread of HIV, hepatitis C and accidental overdoses among people who inject drugs. To bolster direct service efforts, HRAC also works closely with lawmakers, health care providers, law enforcement and the community at large towards the shared vision of a healthy and safe Colorado.
The Harm Reduction Coalition is a national advocacy and capacity-building organization that works to promote the health and dignity of individuals and communities who are impacted by drug use.
OpiSafe.com: a Colorado-based resource and mobile application that gives care providers robust tools to effectively manage patients using opioids.
OpiRescue: a Colorado-based resource and mobile application with resources to help find naloxone and instructions on how to reverse an overdose.
Naloxone Booklet: a resource for patients to help educate them on use of naloxone.
Prescribetoprevent.org: a resource to help find the information necessary to start prescribing and dispensing naloxone rescue kits, including some useful resources containing further information about this life-saving medicine.
The Urban Institute finalized a report in June 2018 that provides a rapid review of evidence on the potential cost savings associated with providing screening, brief intervention and referral to treatment for individuals with substance use disorders (SUDs) related to alcohol and drug use in EDs.