Authors
Kory London, Yutong Li, Jennifer L Kahoud, Davis Cho, Jamus Mulholland, Sebastian Roque, Logan Stugart, Jeffrey Gillingham, Elias Borne, Benjamin Slovis
Source
American Journal of Emergency Medicine, 2024
Conclusions
Fentanyl and xylazine withdrawal, associated with tranq dope, presents significant challenges for both patients and providers in the ED setting. The novel withdrawal order set, which included micro-induction of buprenorphine and supportive medications, was effective in reducing withdrawal symptoms (as evidenced by COWS score improvement) and lowered the AMA discharge rate.
Methods
This was a descriptive cohort study conducted at an urban academic ED, focusing on patients presenting with opioid withdrawal between September 14, 2022, and March 9, 2023. Eligibility criteria included:
- Patients aged 18 and older presenting with opioid withdrawal symptoms.
- Exclusion criteria: stable outpatient management of opioid use disorder (MOUD), pregnancy, or age under 18.
The novel protocol utilized in this study included:
- Micro-induction of buprenorphine
- Short-acting opioids
- Non-opioid analgesics
- Adjunctive medications (e.g., clonidine, antiemetics)
Demographic data, urine toxicology screening, Clinical Opiate Withdrawal Scale (COWS) scores, and patient disposition (including AMA rates) were collected and analyzed.
Results
- Study Population: A total of 270 patient encounters were included. The mean age was 37 years, and 66% of patients were male. Most patients (71%) resided within Philadelphia zip codes.
- Toxicology Findings: 100% of urine toxicology screenings were positive for fentanyl.
- COWS Scores: Among the 177 patients with both pre- and post-treatment COWS scores, the median COWS score decreased from 12 to 4 (p < 0.001).
- AMA Rates: The AMA discharge rate was significantly lower in the study cohort (3.9%) compared to the baseline population with opioid use disorder (10.7%).
- Adverse Effects: Few adverse effects were reported, and all resolved without complications.