Hey, this is Dan McCollum for EM Basic and Farm So Hard podcast.

Here to talk about the use of medications to treat opiate use disorder.

Joining in, my name's R.J. LaCourse here. I'm one of the emergency medicine pharmacists at August

University Medical Center. So, RJ, let's open up with a case. Really common presentation.

You've got a gentleman 33 years old.

He comes in the emergency department.

He's been using heroin for several years now.

He started off on prescription pills, had a problem, eventually graduated to IV drug use.

He hasn't used any opiates in the last 16 hours, and he feels like he's withdrawing pretty hard right now. Normally, he spends about $75 a day on heroin, and he's here for help. Several years ago, if you asked me how to take care of this guy, I would say, hey, he's not having an emergency right this second. I'm just going to give him some clonidine, maybe some zofran, and say, best of luck, buddy,

try to figure it out on your own. But it seems like that's kind of passe now. Right, Dan. That has

been a method of treatment in the past to just address symptoms as they come up, because we know

that unlike alcohol withdrawal, opioid withdrawal is not fatal even in severe cases

so we typically don't treat this as a severe acute distress situation especially when you

consider the stigma associated with this disease state and physicians being trained in the

past that these were not actually patients, but they were simply

there to clog up the ED. So what we can do is treat the opioid withdrawal and get them set up

for success and potentially enrolled in a long-term abstinence program or a medication-assisted

treatment program. Awesome. So we're going to be talking about medication-assisted treatment today, or M-A-T.

And first off, let's set the background.

Why does this matter?

Why is it such a big deal that we up our game when we're treating opioid use disorder?

So the numbers from a couple of years ago showed that over 130 people die every day in

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