• Anita Srivastava, Meldon Kahan, Irene Njoroge, and Leeor Z Sommer.
• Associate Professor anita.srivastava@utoronto.ca.
• Can Fam Physician. 2019 May 1; 65 (5): e214-e220.

ObjectiveTo compare buprenorphine to clonidine for the treatment of opioid withdrawal in the emergency department (ED) and to study the effect assigned treatment medication had on longer-term addiction treatment outcomes.DesignRandomized controlled trial.SettingToronto, Ont.ParticipantsTwenty-six patients presenting to the ED while in opioid withdrawal or soon to be in opioid withdrawal.Main Outcome MeasuresPatients were randomized to receive either clonidine or buprenorphine treatment. Both groups also received a corresponding discharge prescription and information on how to follow up in the addictions rapid access clinic (RAC) within a few days. Participants were followed for 1 month with respect to attendance at the RAC and to opioid agonist treatment status. Outcome measures included attendance at the RAC within 5 days of the initial ED visit and opioid agonist treatment status at 1 month (as determined by clinic attendance or self-report during a follow-up telephone interview).ResultsParticipants who received buprenorphine in the ED were more likely to be receiving opioid agonist treatment at the 1-month mark compared with those participants who received clonidine to treat their withdrawal (P = .011).ConclusionWhen opioid withdrawal is treated with buprenorphine in the ED, patients are more likely to be receiving opioid agonist treatment and connected with addiction treatment 1 month later.Trial Registration NumberNCT03174067 (ClinicalTrials.gov).Copyright© the College of Family Physicians of Canada.

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