//
Microdosing and Standard Dosing Take-Home Buprenorphine from the Emergency Department: A Feasibility Study
Emergency department (ED)–initiated buprenorphine can help to prevent overdose. Microdosing is a novel approach that does not require a patient to first experience withdrawal, which can be a barrier to standard inductions. We aimed to evaluate the feasibility of an ED-initiated buprenorphine/naloxone program providing standard-dosing and microdosing take-home packages and of randomizing patients to either intervention.
We discovered that ED-initiated take-home standard-dosing and microdosing buprenorphine/naloxone programs are feasible, and a randomized controlled trial would be acceptable for our target population.
Published Article: https://pubmed.ncbi.nlm.nih.gov/33392580/
Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada
Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces.
In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C, whose ED visits and hospitalizations were higher than comparison groups.
PubMed Article: https://pubmed.ncbi.nlm.nih.gov/35836121/
Identifying subgroups and risk among frequent emergency department users in British Columbia
Frequent emergency department (ED) users are heterogeneous. We aimed to identify subgroups and assess their mortality. We identified patients ≥18 years with ≥1 ED visit in British Columbia from April 1, 2012 to March 31, 2015, and linked to hospitalization, physician billing, prescription, and mortality data. Frequent users were the top 10% of patients by ED visits.
Our study confirms that distinct subgroups exist within the top 10% of the highest using ED patients, each with unique demographic, clinical, and visit pattern profiles. Our cluster analysis identified 4 frequent user subgroups: complex elderly, middle‐aged with comorbid mental health and alcohol‐related presentations, young with comorbid mental health, and middle‐aged with increased visits over a short term.
PubMed Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823092/
Naloxone dosing in the era of ultra-potent opioid overdoses: a systematic review
In this systematic review, Moe et al. evaluated the relationship between naloxone dose (initial and cumulative) and opioid toxicity reversal and adverse events in undifferentiated and presumed fentanyl/ultra-potent opioid overdoses.
Practitioners have used higher initial doses, and in some cases higher cumulative naloxone doses to reverse toxicity due to presumed fentanyl/ultra-potent opioid exposure compared with other opioids. High-quality comparative naloxone dosing studies assessing effectiveness and safety are needed.
CAEP Article: https://caep.ca/periodicals/Volume_22_Issue_2/Vol_22_Issue_2_Page_178_-_186_Moe.pdf
PubMed Article: https://pubmed.ncbi.nlm.nih.gov/31955714/