2023 14th Annual NUBE Conference

Opiate Use Disorder is a significant public health issue, with substantial implications for individuals, families, and communities. The emergency department often serves as a critical first point of care for individuals struggling with opiate use disorder (OUD). The utilization of suboxone as a medication-assisted treatment (MAT) has quickly become standard of care for patients with OUD presenting to the emergency department. However, since the initial ED dosing for suboxone was introduced, complexities have arisen and potential complications associated with this treatment have come to the fore, including the risk of precipitated withdrawal and the possible requirement for higher doses than are currently FDA-recommended. Understanding the efficacy and potential challenges associated with MAT using suboxone is critical for emergency care providers.Suboxone, a combination of buprenorphine and naloxone, has demonstrated effectiveness in MAT for OUD. However, its use presents specific challenges, including the risk of precipitated withdrawal. This occurs when a patient dependent on full opioid agonists is administered suboxone, causing withdrawal symptoms to occur more rapidly and severely. The published rate of precipitated withdrawal is less than 1%, but that rate may be changing with the advent of fentanyls. We present data from a series of cases across our metropolitan area in this regard. This presentation will provide an in-depth analysis of precipitated withdrawal, its recognition, management, and the steps that can be taken to prevent it when initiating suboxone therapy in the emergency department.The ubiquity of fentanyls has brought about challenges and the potential need for higher doses of suboxone than are currently recommended by the FDA for treating OUD. Buprenorphine, the primary active ingredient in Suboxone, has unique pharmacology and a ceiling effect on respiratory depression, suggesting that higher doses may be safe. In addition, its partial agonist property may render the standard FDA-approved doses less effective, particularly for individuals with severe OUD. The presentation will explore current research, clinical experiences, and ongoing debates regarding this issue, providing attendees with a comprehensive understanding of the topic.- Healthcare professionals need to be able to navigate the complexities of using safely, appropriately, and effectively using suboxone for OUD to improve patient outcomes and reduce the public health burden of OUD.

Learning Objectives:

1. Understand the current science around the use of buprenorphine in OUD, particularly in light of the current prevalence of fentanyl use.
2. Understand available dosing regimens and protocols of suboxone for patients with OUD.
3. Recognize the signs and symptoms of precipitated withdrawal and when higher doses of suboxone or additional agents are needed for its management