For patients who are not in withdrawal but are still looking for help in beginning or continuing their recovery journey, home induction with buprenorphine offers an effective, safe, and time efficient alternative to in ED induction when waiting for the patient to enter withdrawal during a busy ED shift is not feasible.
Clinicians who do have a DEA X waiver can write patients for a short course of buprenorphine after brief patient education on when to administer the medication at home. In this model, clinicians write for no more than 2-3 days of SL buprenorphine(no more than a total of 32-48mg) and send patients home with a step by step guide outlining symptom assessment and dosage information. More information and a clear guideline on home induction for patients here. All patients should have a clear follow up plan in place upon discharge for maintenance treatment.
Departments interested in this approach may consider establishing a waivering program to compel physicians to obtain their DEA X waiver. One example of this is the Get Waivered program which may provide a useful model – overview here.