PCSS-MAUD Webinar: A Practical & Effective Approach to MAUD Initiation in the Emergency Department-Slides

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The webinar presents a practical framework for initiating medications for alcohol use disorder (MAUD) in the emergency department (ED), emphasizing that medication works best alongside peer support, counseling, behavioral health care, and a warm handoff to ongoing treatment.<br /><br />EDs should standardize alcohol withdrawal assessment and treatment with evidence-informed order sets, staff education, stigma reduction, and links to outpatient and residential services. Phenobarbital may be considered for withdrawal treatment, with caution in cirrhosis. Gabapentin can support withdrawal management and may reduce benzodiazepine use, but requires attention to kidney function, fall risk, sedation, and misuse potential. Benzodiazepines and barbiturates are for withdrawal—not long-term AUD treatment.<br /><br />Naltrexone is highlighted as an effective, relatively accessible ED option. Patients need not finish withdrawal before starting, but must be able to consent and should be screened for opioid use or dependence to avoid precipitated opioid withdrawal. Assess for decompensated cirrhosis when clinically indicated. Oral dosing is typically 50 mg daily, timed before the person’s usual drinking period; extended-release injectable naltrexone may help with adherence. Correct preparation and prompt, proper injection technique are essential to prevent painful complications.<br /><br />Acamprosate may help maintain abstinence but is less suited to immediate ED initiation because of three-times-daily dosing, renal adjustment, and early gastrointestinal effects. Gabapentin is not FDA-approved for AUD but may be considered for selected patients. Disulfiram deters drinking rather than reducing cravings; because it depends on supervised adherence and requires liver monitoring, the webinar generally advises against prescribing it from the ED.<br /><br />Overall, successful ED treatment combines careful medication selection with withdrawal management, follow-up planning, and connections to supportive care.

Keywords

alcohol use disorder

emergency department

MAUD

naltrexone

withdrawal management

gabapentin

phenobarbital

acamprosate

disulfiram

warm handoff