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ED-Initiated Buprenorphine Video

Video transcript

DR. D’ONOFRIO: Hi Mr. Coleman, I’m Dr. D'Onofrio. I’m going to be taking care of you today. So, do you mind if I spend a few minutes talking to you about your heroin use?

MR. COLEMAN: Whatever.

DR. D’ONOFRIO: So, it seems like you were brought in by ambulance after a friend called 911. Do you remember any of that?

MR. COLEMAN: Yeah, a little bit. I don't really know what happened.

DR. D’ONOFRIO: So, I guess they gave you some Naloxone, which is the reversal for an opiate overdose, sir. It looks like you were taking some heroin.

MR. COLEMAN: Yep. I just know that my girlfriend brought me here and I woke up here and I’m just—she called 911 and then she just left. I just got out of this three-week rehab program, I’m supposedly off everything, and I guess that didn’t work out so well.

DR. D’ONOFRIO: Well, I’m not surprised now that you told me that, because when you’re in rehab and now using, your body becomes less tolerant, and actually that’s one of the biggest risks of overdose, is being in a rehab. Addiction causes all this kind of rewiring in your brain, and when it’s rewired, it doesn’t get quickly as possible, so that I’m not surprised that you started craving and using more heroin and that you ended up here today.

 MR. COLEMAN: Yeah. Look, I guess I just, I got to get out of here. I’m just starting to feel like crap.

DR. D’ONOFRIO: Yeah, I can see that you’re starting to withdraw, but do you see some relationship or any connection between your use and being here?

MR. COLEMAN: Yeah, I get it, but I know what to do now.

DR. D’ONOFRIO: Okay. I’m really afraid that you might overdose again, and so that you know, it has really nothing to do with your willpower, and it has nothing to do with your ability to try to control it totally by yourself. I have some medication that’s called buprenorphine, often known as Suboxone, that may help you with some of this. Are you willing to at least consider using some?

MR. COLEMAN: I don't know. I thought about doing that but decided against it because it’s really just replacing one drug for another, and I just got a new job and I’m just not trying to go through all this again.

DR. D’ONOFRIO: Well, I understand how you could think that, but it is really a medication that has been proven to be very effective to stop this withdrawal and craving, and it’s like insulin for diabetics. But I can see that you are really, really in severe withdrawal. How about I just give you a little bit of the buprenorphine now? Then we can have this conversation in about a half hour.

 MR. COLEMAN: All right.

DR. D’ONOFRIO: Would you consider that?

MR. COLEMAN: Yeah, if maybe if I try some treatment everyone will be less upset with me. It’s worth a try.

DR. D’ONOFRIO: Okay, great. Have you used any long-acting drugs like methadone or OxyContin or anything like that, or just the heroin?

MR. COLEMAN: Just the heroin. I’ve tried some of that other stuff, but since I’m out I’ve just been using heroin.

DR. D’ONOFRIO: Then I’m going to bring the nurse and we’re going to give you some and you’re going to feel a lot better. Then I think we’ll be better able to continue to the conversation, okay?

MR. COLEMAN: All right, that sounds good.

DR. D’ONOFRIO: All right, good. I’ll be back in a minute and she’ll be right in.

Mr. Coleman, you look a lot better, do you feel more comfortable?

MR. COLEMAN: Yeah, I do, thank you.

DR. D’ONOFRIO: Okay, so I’d want to continue this conversation, and so what are you thinking? You look like you’d be a great candidate for this, because the medication really did work. On a scale of 1 to 10, 1 being totally not ready and 10 being ready to start treatment with buprenorphine, where do you think you fit in that?

MR. COLEMAN: I guess a 7. I don't know, I mean I do feel better. It would be worth a shot.

DR. D’ONOFRIO: Okay, great, so you’re 70% ready, that’s really fantastic. What are some reasons why you didn’t choose a lower number? So you must have reasons that you want to change.

MR. COLEMAN: I mean, I do feel better and, you know, you could be right. It might be a good fit for me and I, you know, I just feel like I’ve let everyone down and I just want to make a change, so…

DR. DR. D’ONOFRIO: I think that you didn’t let everyone down. We’re—it’s not unexpected that people don’t do well trying the first time, and I suspect that this is really a great opportunity for you to get back on track again. So, it would be less cravings, less withdrawal, and pretty much let you get on with your life.

MR. COLEMAN: Yeah, I mean that all sounds good.

DR. D’ONOFRIO: Okay, great. So, let me tell you some other things that we need to do. I need to draw a little bit of blood to look at your liver function test and make sure that your liver is fine so that we can continue this treatment, and I’m going to refer you to one of our treatment providers who’s an addiction specialist here in New Haven. You live in New Haven, correct?

MR. COLEMAN: Mm-hm.

DR. D’ONOFRIO: Okay, good. So, I can set you up for an appointment probably on Friday morning at nine, if that works for you?

MR. COLEMAN: Sure.

DR. D’ONOFRIO: Okay, and I’m going to give you a little bit more medication of the buprenorphine, now that I know that the first worked and it—you didn’t have any complications for it, so I’m going to give you a little bit more before you leave. Is that okay with you?

 MR. COLEMAN: Yeah, that’s fine.

DR. DR. D’ONOFRIO: All right. And then also, the other really important thing is that I’m going to have the nurse come in and talk to you about this Narcan or naloxone kit. We really like you to learn how to use it, and so your friends and family can also learn how to use it in case you get into another overdose situation. So, I’m going to have the nurse talk to you about that. She’s going to give you a little bit more medication and she’s going to give you a direct appointment for Friday morning at nine o’clock to get more follow-up, all right?

MR. COLEMAN: All right.

DR. D’ONOFRIO: And we’re going to follow up to make sure that you got to that appointment, okay?

MR. COLEMAN: All right, that sounds good, thank you.

DR. D’ONOFRIO: Okay, great. I’m really glad that you made this decision.

MR. COLEMAN: All right.

DR. D’ONOFRIO: Take care.

 

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