1. There are three MAT drugs available to treat addiction: naltrexone (brand name Vivitrol), methadone (brand names Dolophine or Methadose) & buprenorphine (brand name Suboxone, Subutex, and Sublicade).
  2. The only MAT drug appropriate for initiation in the ED is buprenorphine.
  3. Buprenorphine is a semi-synthetic opioid which acts as partial agonist at the mu receptor. Buprenorphine does not produce as much euphoria or as much of the respiratory depression seen with other opioids. It has a quick onset and long half-life and is usually administered sublingually. The most commonly used formulation of buprenorphine is mixed with naloxone for one reason and one reason only – to prevent diversion and IV drug use. When taken orally, the buprenorphine effect is predominant; when taken IV, the naloxone effect is predominant
  4. Any ED provider can administer buprenorphine in the ED for up to 3 consecutive days in order to bridge a patient to addiction services.
  5. X-Waivers allow you to prescribe buprenorphine from the ED, which is a great service you can provide your patients, particularly in rural communities. In 2019 ACEP will be producing an ED physician specific X-Waiver training which will focus exclusively on ED-based care.

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