Fear and Loathing in the ED: When Staff Are Afraid to Provide Compassionate Care

Opiate use disorder has a wide range of physical and social complications that often present first in the emergency department. Physiological dependence may interfere with a patient’s own attempts to detox from opiate drug use. As a result, emergency providers are faced with difficulty discerning an opiate-dependent patient’s genuine intent, especially when he or she is experiencing withdrawal. Seemingly paternalistic actions may be justified when the patient’s stated goals of “getting clean” conflict with his or her more urgent demands for opiates to end debilitating withdrawal symptoms. Individual capacity may be compromised by drug dependence. Novel approaches adapted to the emergency setting, such as medication-assisted therapy (MAT) with buprenorphine induction can help patients suffering from opiate withdrawal and mitigate conflict that may occur when patients feel undertreated by typical pharmacological approaches to withdrawal. Clinical, mental health, and legal options exist to help treat opiate withdrawal, but their applications are not without ethical dilemmas.