Treating substance use disorders in the Emergency Department-Recording - Treating Substance Use Disorders in the Emergency Department

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Video Summary

Dr. Tony Spadaro, an emergency medicine physician and addiction specialist, discusses treating substance use disorders (SUD) in the emergency department (ED). He emphasizes that ED visits are critical "reachable moments" to screen, diagnose, initiate treatment, and link patients to long-term care for SUDs, particularly opioid and alcohol use disorders.<br /><br />Key points include consensus guidelines supporting medication initiation for opioid use disorder (OUD) in the ED using buprenorphine or methadone. Buprenorphine is favored for its safety and effectiveness but requires managing withdrawal timing, especially with prevalent fentanyl use, which complicates induction due to risk of precipitated withdrawal. Strategies include standard, microdosing, and high-dose inductions. Methadone, a full opioid agonist with a long half-life, is useful for patients who prefer it or have concurrent pain but requires careful dosing and clinic access considerations. Both medications significantly reduce mortality.<br /><br />For alcohol use disorder, naltrexone is often initiated in the ED to reduce cravings, while other agents like acamprosate, gabapentin, and topiramate have roles but varying evidence. Disulfiram is less commonly used due to risks. ED clinicians should also provide naloxone for overdose reversal as a preventive measure.<br /><br />Spadaro highlights the importance of screening with quick tools, addressing co-occurring psychiatric and stimulant or cannabis use disorders, and involving substance use navigators for care linkage. Future directions include long-acting injectable buprenorphine, emerging pharmacotherapies, and greater focus on nicotine cessation. Overall, initiating evidence-based medication and referral from the ED improves outcomes and saves lives.

Keywords

emergency department

substance use disorders

opioid use disorder

buprenorphine

methadone

alcohol use disorder

naltrexone

naloxone

addiction treatment