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Management of Opioid Use Disorder in the Hospitali ...
Q&A from 9-26
Q&A from 9-26
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The document contains a Q&A session from an adolescent opioid use disorder (OUD) training program, discussing various aspects of patient care and management. Here’s a summary:<br /><br />**Hydration:** Juice is considered less hydrating than water due to its sugar content. IV hydration is generally used for very ill patients or those experiencing vomiting or diarrhea.<br /><br />**COWS scale assessment:** A baseline COWS (Clinical Opiate Withdrawal Scale) assessment is recommended upon admission, with reassessment every four hours until a certain threshold is reached to begin medication for opioid withdrawal.<br /><br />**Staff involvement:** Residents, along with nurses, use MD Calc for COWS scores on their phones. Hospitalists provide coverage for patients experiencing withdrawal symptoms during off-hours, with full phone coverage available 24/7.<br /><br />**Training and Education:** Residents receive training during noon conferences and are advised to contact addiction medicine for guidance in severe withdrawal situations.<br /><br />**Behavioral and Safety Concerns:** Violent behaviors in these patients are not typical, but 1:1 sitter arrangements may be preferred for overnight admissions. Communication strategies include showing interest and empathy, avoiding mirroring potentially harmful language from parents.<br /><br />**Treatment Refusal and Emergency Commitment:** In Connecticut, a licensed psychiatrist can involuntarily commit a patient refusing treatment for up to 15 days using a physician emergency certificate, following an assessment.<br /><br />**Medication Interactions:** Nicotine patches don't contraindicate the use of sublingual buprenorphine, but patients should avoid nicotine products shortly before or after taking it. Baseline EKGs aren't standard for buprenorphine initiation, but may be required if drug interactions risk QT prolongation.<br /><br />**Legal Protections:** Administering naloxone outside the hospital is protected under Good Samaritan Laws, and healthcare workers’ risk of fentanyl exposure is very low if universal precautions are followed.<br /><br />**Continuity of Care:** Local health centers and programs provide follow-up care and medication for discharged patients, with specialized programs available for young patients.<br /><br />This training provides comprehensive guidance for managing adolescent OUD in both clinical settings and emergency situations.
Keywords
adolescent OUD
hydration
COWS scale
staff involvement
training and education
behavioral concerns
treatment refusal
medication interactions
legal protections
continuity of care
The content on this site is intended solely to inform and educate medical professionals. This site shall not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional.
Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 and grant no. 1H79TI085588 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
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