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Overcoming barriers to micro-dose Suboxone initiation from ER
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In Victoria we have started micro-dose inductions of patients with opioid use disorder to build on the success of standard opioid inductions started in 2017 ( over 200 to date! ).We want to make this a minimal barrier process, ideally with patient leaving with a blister pack of Suboxone micro dose with instructions and daily partitioned doses and linkage to outpatient OAT providers. It may take several days to get to outpatient provider so dispensing multiple days of the induction regime makes sense.
We have come up against a hard barrier of inability to dispense more than 24 hours of medication from the ED according to our pharmacy colleagues.
Is this a legislative barrier, an edict from college of pharmacies or a local health authority ( Island Health) issue?
Has anyone been able to set up a program that allows them to dispense blister packs from the ED for this vulnerable population?
It seems with the opioid death rate and the extra financial and political resources cast into this arena that this sort of barrier should be easily surmountable?
Jason Wale, Victoria BC
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Hey Jason, in Terrace (Northern Health) we have to-go packs of suboxone we can dispense from the ED. I think it's 3 or 4 days of medication which covers them for enough time to see the OAT clinic regardless of what day the induction was started. We don't have anything for microdosing but I think the principle of hospital pharmacy dispensing should be the same? -
Minimal small ER standard supports
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HiJust wondering if there is any work/research/thoughts anywhere about what are the minimum standards to work in an ER. I see some ERs have no lab or XRAY. Some have limited POC. Some have one nurse and others have none. In some ERs , the docs are first call.
Is there a link between the population, which in turn dictates the acuity and frequency of the cases and the minimum standards ER docs need to have to support quality care?
Just curious if anyone has ever thought about this?
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Do we even have an inventory of what services BC EDs provide, or the hours? Or in Australian terms, what level the EDs qualify as? Interestingly, the Australian document says nothing about data. (For example, whether the notes are electronic or paper, or where data [ie discharge diagnoses] are sent...)
Dr. Jocelyn Andruko
February 5, 2021