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Letter to the editor: The slippery slope of buprenorphine : Emergency Medicine News

Editor:

I am board certified in emergency medicine and addiction medicine and medical director of the Recovery Centers of America in South Amboy, NJ, a hospital facility where we perform detox reductions with buprenorphine. (REM. 2021;43[10]:6; https://bit.ly/3ipxkjb.)

Giving patients buprenorphine in the emergency room is much more complex than comparing opioid addiction to asthma. It’s a slippery slope. My first concern is that ER doctors are going to put a lot of patients into rushed withdrawal, which is the most miserable experience for patients and has no great treatment options to correct. It will be a nightmare for patients and providers in the emergency department.

I wonder what the ER plan is for discharged patients. Will you send patients home with a buprenorphine maintenance prescription? It’s a big deal to start patients on this topic, and it’s extremely controversial. If you give them a prescription for buprenorphine, what is the plan for them to get rid of it? Coming out is extremely difficult and usually requires a week-long detox protocol where the drug is reduced, often in a hospital setting.

Opioid addiction is complex and goes beyond a single emergency department visit. I understand that PEs want a tool to help patients in distress, but there’s a lot in there. Once the news broke, patients could go to the emergency room daily for a dose of buprenorphine. It will burden emergency services and could prevent patients from connecting to the long-term care they need to properly treat their addiction.

Andrew Youssouf, MD

South Amboy, New Jersey