Acad Emerg Med

SAEM publishes new guideline for treatment of nonopioid use disorders in the ED

June 4, 2024

The SAEM GRACE-4 Writing Team, composed of emergency physicians and experts in addiction medicine and patients with lived experience, applied the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding six priority questions for adult ED patients with alcohol withdrawal syndrome, alcohol use disorder, and cannabinoid hyperemesis syndrome.

Key recommendations:

(1) In adult ED patients (over the age of 18) with moderate to severe alcohol withdrawal syndrome who are being admitted to hospital: Suggest using phenobarbital in addition to benzodiazepines compared to using benzodiazepines alone [low to very low certainty of evidence]

(2) In adult ED patients (over the age of 18) with alcohol use disorder who desire alcohol cessation: Suggest a prescription for one anticraving medication [very low certainty of evidence]

(2a) In adult ED patients (over the age of 18) with alcohol use disorder: Suggest naltrexone (compared to no prescription) to prevent return to heavy drinking [low certainty of evidence]

(2b) In adult ED patients (over the age of 18) with alcohol use disorder and contraindications to naltrexone: Suggest acamprosate (compared to no prescription) to prevent return to heavy drinking and/or to reduce heavy drinking [low certainty of evidence]

(2c) In adult ED patients (over the age of 18) with alcohol use disorder, we suggest gabapentin (compared to no prescription) for the management of alcohol use disorder to reduce heavy drinking days and improve alcohol withdrawal symptoms [very low certainty of evidence]

(3a) In adult ED patients (over the age of 18) presenting to the ED with cannabinoid hyperemesis syndrome we suggest the use of haloperidol or droperidol (in addition to usual care/serotonin antagonists, eg, ondansetron) to help with symptom management [very low certainty of evidence];

(3b) In adult ED patients (over the age of 18) presenting to the ED with cannabinoid hyperemesis syndrome: Also suggest offering the use of topical capsaicin (in addition to usual care/serotonin antagonists, eg, ondansetron) to help with symptom management [very low certainty of evidence].

Source:

Borgundvaag B, et al. (2024, May 31). Acad Emerg Med. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. https://pubmed.ncbi.nlm.nih.gov/38747203/