BUPRENORPHINE 

.BupED 

 

Last opioid use: ***

Recent Methadone use: no***

Withdrawal symptoms: ***

Pt with presentation suggestive of opioid withdrawal, considered but doubt alternative medical etiologies for patient’s symptoms, patient without other significant medical comorbidities, plan to start on buprenorphine for opioid withdrawal. 

Patient given 8mg test dose of buprenorphine. 

30 min after first dose patient felt ***. 

Offered patient choice for 2nd dose:  low (8mg), medium (16mg), or high (24mg).

Patient elected 2nd dose of ***mg.   

Discharge plan for sublingual Suboxone 8mg BID until seen at ED Bridge clinic.  

Patient directed for follow up to ED Bridge clinic T/Th 9a-2p. 

Page or follow up email was*** sent to SUN@alamedahealthsystem.org.

I have*** prescribed Naloxone and completed patient education for overdose prevention

.BupDC

You were introduced today to a medical therapy for opioid addiction called buprenorphine.  Buprenorphine comes in strips that dissolve under your tongue.  We are giving you strips to use at home to keep you from feeling withdrawal symptoms (sometimes called "kicking" or "dope sick").  Take the strips as directed.  Most importantly, please return to our ED Bridge Clinic on Tuesday or Thursdays between 9am-2pm (clinic is located Highland Hospital wing A1).  You do not need an appointment to come, and you should still come even if you are still using.  We have given you another medicine called Naloxone (Narcan) to take home today.  This is a reversal medicine to treat overdose.  Please have this available if you or your friends do continue to use in the future.   

If you are feeling concerning symptoms before you are able to make it to a bridge appointment, please return to the emergency room right away.  

------------------------------------------------------------------------------------------------------------------------

Naltrexone


 

.NaltrexoneED

Patient has an alcohol use disorder and has expressed desire to reduce alcohol consumption.

History of seizure: ***   
Past admission for etoh: ***

Self reported drinking days in past week: ***

Patient does not*** endorse using opioids (no Naltrexone if pt uses pills, heroin, methadone, or buprenorphine)

Patient does not*** have cirrhosis or acute liver injury (no Naltrexone of LFT>250)

Patient does not*** have CKD or renal failure (no Gabapentin if eGFR<60)

***Patient prescribed Gabapentin 600mg*** TID for protracted withdrawal suppression.  

***Patient prescribed Naltrexone 50mg PO daily (#14 tabs) for craving suppression.  

Substance Use Navigator (SUN) was ***contacted to help arrange followup and address logistical barriers for patient

***Patient instructed to follow up at ED Bridge clinic T/Th 9a-2p, bridge clinic will discuss Vivatrol injection if patient doing well on Naltrexone

.NaltrexoneDC

You have two new medicines. 

#1) Naltrexone - it helps reduce your cravings or urge to drink.  It will NOT make you sick if you continue to drink.   You take it once daily until you follow up in our Bridge clinic. 

#2) Gabapentin - it helps reduce your physical symptoms of withdrawal when you start to drink less (can't sleep, anxiety, tremor).  Please take as directed.  

Please come to ED Bridge Clinic on Tuesday or Thursdays between 9am-2pm (clinic is located Highland Hospital wing A1) to follow up and they can help you adjust your therapies for long term success. 

Please come to clinic even if you continue to drink. 

If you have concerning symptoms or seizures people come back to the emergency department.