The following article is part of conference coverage from the 2019 American Academy of Physician Assistants Annual Meeting (AAPA 2019) in Denver, Colorado. Clinical Advisor’s staff will be reporting breaking news associated with research conducted by leading physician assistants. Check back for the latest news from AAPA 2019.


DENVER — Initiating buprenorphine in the emergency department (ED) may improve retention rates in opioid use disorder treatment programs, reduce illicit opioid use, and curb the mortality rates associated with long-term opioid use, according to research presented at the American Academy of Physician Assistants (AAPA) annual meeting, held May 18 to 22, 2019, in Denver, CO.

Student researchers from the University of California Davis Physician Assistant Program created a protocol to initiate buprenorphine in the ED for patients with suspected opioid withdrawal. The 11-item Clinical Opiate Withdrawal Scale (COWS) is to be used to categorize the severity of opioid withdrawal symptoms, and patients with a COWS score ≥5 would receive buprenorphine.

Continue Reading

The investigators conducted a search of the medical literature that revealed buprenorphine to be more successful than either referral or a brief intervention for reducing illicit opioid use. Buprenorphine administration was associated with a decrease in both opioid-related and all-cause mortality when compared with methadone. Administration of buprenorphine was also found to be associated with a decrease in both pharmacy and overall medical costs over a 12-month period.

The research team proposed the following evidence-based protocol: assessment in the ED of a patient with suspected opiate withdrawal is to include nurse screening and use of the COWS. For patients with a COWS score ≥5, assessment by the ED provider and administration of buprenorphine would be followed by social work consultation to schedule outpatient follow-up.

Related Articles

Implementation of the protocol beyond one year and at multiple locations will help to ensure the validity of the intervention.

For more coverage of AAPA 2019, click here.


Genove FA, Cueva L, Francisco EM, et al. Developing a protocol for initiating buprenorphine in the emergency department: systematic review. Presented at: The American Academy of Physician Assistants (AAPA) Annual Meeting; May 18-22, 2019; Denver, CO. Poster 172.