How to engage opioids addicts in successful treatment

How-to-engage-opioids-addicts-in-successful-treatmentAs a doctor, would you give a junkie a narcotic in hopes of weaning him or her off their opioid addiction? You may think that would be tantamount to adding fuel to fire – or more like fighting fire with fire, according to a recent study published in JAMA. Researchers from Yale University found that patients addicted to heroin or painkillers who were given the partial opioid agonist buprenorphine in an emergency room were more likely to seek and stick to a treatment program in the ensuing 30 days than those who were offered a referral or a short staff-conducted counseling sessions (the former patients also decreased the length of their habit, but that was self-reported and, given who we’re talking about here, should thus be taken with a grain of salt).

Study co-author and chair of emergency medicine at Yale School of Medicine Gail D’Onofrio and colleagues randomized 329 voluntary patients – tested for opioid addiction, suffering from an OD, or willfully seeking treatment – into three different clusters; a referral group, a brief intervention group, and a buprenorphine treatment group. The first group was instructed on where to find in-patient and out-patient treatment; the second was given a more detailed explanation on the importance of seeking help in addition to the first group’s instructions; and the third was given the instructions, the explanation, and an immediate dose of buprenorphine combined with naloxone, which relieves withdrawal and craving symptoms and helps prevent recidivism.

“Prior research at Yale has demonstrated that buprenorphine treatment is highly effective in primary care, and this study was designed in part to expand the reach of this treatment to this critical ED patient population,” professor of medicine and chief of general internal medicine at Yale School of Medicine Dr. Patrick O’Connor said in a statement. The new study confirmed this assessment. “The patients who received ED-initiated medication and referral for ongoing treatment in primary care were twice as likely than the others to be engaged in treatment 30 days later,” D’Onofrio explained. “They were less likely to use illicit opioids of any kind.”

Study results after 30 days


Engaged in treatment

Days of illicit opioid use/week

Referral group


.9 (from 5.4)

Intervention group


2.3 (from 5.4)

Buprenorphine group


2.4 (from 5.6)


 D’Onofrio remarked that addicts who resort to the ER are already in dire straits – more like in Alice in Chains, though, if you know what I mean – but “ED physicians take care of the immediate concern, but don’t treat the underlying problem. Opioid dependence and overdose is an escalating problem that has really reached epidemic proportions here in the US,” she told JAMA in a video interview. “The emergency department is often the place where patients with opioid dependence seek their care, so it makes sense that this would be the place where we would try to screen and intervene for this very significant problem.”

The study – the first-ever to compare the combination of buprenorphine and referral services with the standard referral and counseling procedure – indicated that patients who were administered buprenorphine not only required less in-patient treatment in a residential facility but “better results and less utilization of resources,” according to study co-author and professor of medicine Dr. David Fiellin. O’Connor added that “effectively linking ED-initiated buprenorphine treatment to ongoing treatment in primary care represents an exciting new model for engaging patients who are dependent on opioids into state-of-the-art care.”

“(Opioid addiction) is a huge public health problem,” D’Onofrio said. “We’ve offered another expanded use of the ED to increase access to treatment options for people with this chronic and relapsing condition.” She did note however that “buprenorphine does require special training and a waiver from the FDA in order to prescribe it, which does set up some barriers.” Nevertheless, the researchers hope the study will spark discussion on new ways to approach an addiction that is responsible for more daily casualties that car crashes. And sometimes, the poison just happens to be cure as well.


Related Read:

How common is pain relief medications addiction?

Opioid Addicts Who Visit ER Benefit From Buprenorphine Drug Treatment, Intervention

Successfully Engaging Opioid-Dependent Patients in Addiction Treatment

Emergency department treatment for opioid addiction better than referrals