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

Des Plaines, IL — The Society for Academic Emergency Medicine (SAEM) is pleased to announce its latest addition to the Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) series. This fourth publication, focusing on emergency department (ED) management of nonopioid use disorders, specifically addresses alcohol withdrawal syndrome (AWS), alcohol use disorder (AUD), and cannabinoid hyperemesis syndrome (CHS). The article, titled Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol Use Disorder and Cannabinoid Hyperemesis Syndrome Management in the Emergency Department, is now available in the May issue of SAEM’s peer reviewed journal, Academic Emergency Medicine (AEM).

Conditions associated with heavy alcohol consumption are common and increasingly encountered in the ED. Following the legalization of cannabis, trends in the United States show a similar increase in ED presentations related to cannabis use.

“According to the 2022 National Survey on Drug Use and Health 11.2% of adults over age 18 had alcohol use disorder in the preceding year. In addition, 2.75 million Americans may suffer cannabinoid hyperemesis syndrome annually,” shared Christopher R. Carpenter, MD, MSc, chair of the SAEM GRACE steering committee. “Despite the frequency of these presentations, medical management of these conditions in the ED has been highly variable with missed opportunities for more proactive care.”

Research and education focused on the management of conditions related to the use of these substances, particularly in the ED setting, is limited. The objective of this guideline is to provide clinicians with an evidence-based, patient-centric framework for evaluating and managing AWS, AUD, and CHS. According to Dr. Carpenter, “SAEM GRACE-4 provides emergency physicians with GRADE-adherent clinical practice guideline recommendations to provide more patient-centered care for these vulnerable populations.”

A diverse panel of experts and patient stakeholders assessed the certainty of evidence concerning specific priority questions pertaining to adults presenting with AWS, AUD, or CHS in the ED. Subsequently, they formulated evidence-based recommendations and good practice statements grounded in both direct and indirect evidence.

To develop this clinical practice guideline, the SAEM GRACE-4 writing team used Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology, a widely adopted framework utilized by numerous organizations across the globe for assessing the quality of available evidence and formulating clinical practice recommendations.

The lead author of the study is Bjug Borgundvaag, MD, PhD, director of the Schwartz/Reisman Emergency Medicine Institute (SREMI) at Sinai Health System and professor of emergency medicine in the Department of Family and Community Medicine at the University of Toronto. 

Dr. Borgundvaag shared insights on the study findings:

“Research that rigorously evaluates the SAEM GRACE-4 recommendations is required to direct care in the ED. While we await more evidence to guide practice, the SAEM GRACE-4 Writing Team strongly recommends offering brief ED substance use disorder interventions and facilitating referrals to psychosocial support services or outpatient services within the community wherever available.”

The SAEM GRACE program addresses the best practices for the care of the most common chief complaints that can be seen on the tracking board of any ED in the country, based upon research and expert consensus. These guidelines are designed with de-implementation as a guiding principle to reasonably reduce wasteful testing, provide explicit criteria to reduce foreseeable risk, while defining sensible and prudent medical care. In addition to SAEM GRACE-4, SAEM GRACE Writing Teams have previously published guidelines for acute dizziness and vertigo, recurrent, low-risk chest pain and recurrent, low-risk abdominal pain. An SAEM GRACE Writing Team is currently working on clinical practice guidelines for syncope.

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ABOUT ACADEMIC EMERGENCY MEDICINE

Academic Emergency Medicine, the monthly journal of Society for Academic Emergency Medicine, features the best in peer-reviewed, cutting-edge original research relevant to the practice and investigation of emergency care. The above study is published open access and can be downloaded by following Journalists wishing to interview the authors may contact Laura Giblin at lgiblin@saem.org.

ABOUT THE SOCIETY FOR ACADEMIC EMERGENCY MEDICINE

SAEM is a 501(c)(3) not-for-profit organization dedicated to the improvement of care of the acutely ill and injured patient by leading the advancement of academic emergency medicine through education and research, advocacy, and professional development. To learn more, visit saem.org.