2023 14th Annual NUBE Conference

INTRODUCTION: Medical detoxification (detox) programs are widely known to have medical staff close by to aid with patients who demonstrate symptoms of alcohol withdrawal. When medical detox programs are a limited resource, Phenobarbital can be the solution in an ED. Phenobarbital is a medication used to manage alcohol withdrawal symptoms and has a long half-life, but outcomes are not well studied among patients who receive Phenobarbital in the ED, and discharged from the hospital to a social detox program. The objective of this case series was to 1) develop a protocol in the ED with AUD (alcohol use disorder) patients, 2) reduce withdrawal symptoms while at a social detox program, and 3) to make prescribing AUD medication at discharge, obsolete. METHODS: The case series was conducted at a research and teaching hospital Emergency Department (ED) in California. Patients who arrived at the ED suspected of heavy alcohol consumption, concerned about withdrawal, and wanted to be discharged to a substance use treatment program (a community partner), were administered Phenobarbital. A combination of criteria determined the Phenobarbital dose, including, triage vital signs, seizure history, daily alcohol consumption, and The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR) score. There were weekly updates between the ED provider champion, substance use navigator (SUN), and a community partner liaison, to monitor if patients had alcohol withdrawal complications throughout participation. RESULTS: Between January 2022 to June 2023, the ED referred 85 patients to Salvation Army’s Harbor Light social detox program, a 30-day or longer residential treatment program, and community partner, located in San Francisco, CA. Some 20% (n=17) met the criteria to be administered phenobarbital, a medication used to treat alcohol withdrawal symptoms, in the ED. Most (82%) identified as male, and majority (65%) identified as White/Caucasian. The preferred alcohol type was liquor (59%), most (65%) consumed more than 6 drinks per day, and majority (76%) stayed at Harbor Light longer than 72 hours (about 3 days). CONCLUSIONS: Patients who arrived at the ED suspected of heavy alcohol consumption, received Phenobarbital, and were discharged to the social detox program had zero alcohol withdrawal complications, and did not return the ED within the crucial 72-hour period. It is within the 72-hour period when alcohol withdrawal symptoms would be expected to develop and be seen. Our case series has a promising approach and deserves further research.

Learning Objectives:

1. To develop a protocol in the ED with AUD (alcohol use disorder) patients.
2. Reduce withdrawal symptoms while at a social detox program.
3. To make prescribing AUD medication at discharge, obsolete.