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Learning about Opioid Use Disorder (LOUD) in the Emergency Department Resources

Date: March 19, 2020
Filed under: Substance Use,

Learning about Opioid Use Disorder (LOUD) in the Emergency Department (ED) is a provincial quality improvement initiative focused on ED care for people who use opioids. Check out some of the informative resources below to help you and your team get started on your improvement journey!

COVID-19 Update

The ability of our emergency care system to respond to the pandemic is paramount. Although we have decided to postpone the launch of the Learning about Opioid Use Disorder (LOUD) in the Emergency Department Collaborative, the overdose crisis in BC and beyond continues, and we remain committed to improving care for people who use opioids and the experience of OUD care for people and providers.

The BC Centre on Substance Use is developing new guidance in the context of COVID-19:

Latest Information for OAT Prescribers & Pharmacists
Updated Clinical Guidance for Dual Public Health Emergencies

Watch this Ted Talk Is Safe Supply a Viable Option for the Overdose Crisis? Guy Felicella advocates for harm reduction on behalf of British Columbia’s Overdose Emergency Response Centre, Vancouver Coastal Health’s Regional Addiction Team and the British Columbia Centre on Substance Use. He is also a LOUD in the ED Faculty member.

Getting Started

This resources page is full of links, documents and online training to support your quality improvement journey to improve OUD care in the ED. Resources have been organized by the following drivers of improvement:

  1. Recommended Clinical Decision Support Tools

Implementing recommended practices to inform order sets and guideline development. There is a wide variety of emerging research around buprenorphine-naloxone starts in the ED. We have included a collection of identified resources, Pre Printed Orders (PPOs) and guidelines by our provincial expert faculty to help guide you in making informed decisions for people with OUD presenting at your ED.

2. Clinical Education and Strategies

Current trainings, culture change and opportunities. Some of the evolving and growing variety of formal training opportunities for clinicians around OUD guidelines.

3. People- and Provider-Centred Care

Stigma, engagement and access. People with OUD’s long-term relationship with the health care system, as well as their experiences accessing care and treatment, is often dictated by the nature of their first experience with the ED. Having a better understanding of trauma-informed practice, early identification and better clinical understanding of what OUD care looks like can help enhance this experience to be a more positive one – both for people presenting in the ED and for providers. This section of our resource list also includes a link to EQUIP, a series of free online modules around trauma- and violence informed practices, and culturally appropriate care.

4. Connection Continuum

Bridging community and ED care. Helping people with OUD get connected with the resources they need in the community is an important part of care. These connections are sometimes tricky to navigate, but ultimately can help with a smooth transition to community supports. Better transitions and awareness of community resources can improve outcomes for people with OUD.

Tools & Resources

PPO Examples

Island Health Buprenorphine-Naloxone (Suboxone®) Induction Orders*PDF*
Sample clinical order set for Buprenorphine-Naloxone provided by Island Health Authority.

Fraser Health Authority Buprenorphine-Naloxone (Suboxone®) Induction Orders *PDF*
Sample clinical order set for Buprenorphine-Naloxone provided by Fraser Health Authority.


Patient Information: ER Suboxone Self Start Instructions *PDF*
Two-page document from Island Health Authority outlining patient instructions for dosing up to eight (8) 2mg Suboxone tablets dispensed from the ER.

Take Home Suboxone® (buprenorphine-naloxone) *Doc*
Document from Fraser Health Authority outlining patient steps for taking Suboxone®, tracking their own withdrawal, and OAT clinic information.

Buprenorphine use in the Emergency Department (BUPE) Tool *Link*
Bedside tool for using buprenorphine. Developed by the American College of Emergency Physicians and available as a phone app. NOTE: This is an American resource that uses induction protocols and COWS initiation that deviate from recommended practice in BC.

ED Initiated Buprenorphine & Referral to Treatment *PDF*
A brief guide for ED Practitioners from the Yale School of Medicine.

Internet Book of Critical Care: Buprenorphine & Opioid Use Disorder *Link*
Online textbook section by Josh Farkas, associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.

Management of Opioid Use Disorder in the Emergency Department *PDF*
White paper from the American Academy of Emergency Medicine that aims to provide evidence-based recommendations for providers in acute care setting managing patients who use opioids.

The California Bridge Model *Link*
This website is full of information outlining the California Bridge program which aims to improve care for people with substance use disorders.


Click here to download a one-page summary document os the different Substance Use Education & Training opportunities at the BC Center for Substance Use

Addiction Treatment & Care Online Certificate (ACTOC) *Link*
The Addiction Care and Treatment Online Certificate is a free online certificate course targeted at health care professionals interested in learning more about providing care to patients with various substance use disorders, including alcohol, tobacco, stimulants, cannabis, and opioids. This program was supported by an investment by the Province of British Columbia and the Ministry of Health.

Provincial Opioid Addiction Treatment Support Program (POATSP) *Link*
This program is geared towards opioid agonist treatment prescribers, including both physicians and nurse practitioners, however, all health care providers (e.g., nurses, pharmacists, social worker, counsellors, etc.) can benefit from the online education modules. Completing this course is the first step in the authorization process for those wishing to prescribe opioid agonist treatments (OAT) for the treatment of opioid use disorder. The full program will take learners 8-10 hours to complete and is free and CME accredited. Learners may also choose to take the buprenorphine/naloxone stream which takes 4-6 hours to complete. This course must be completed before methadone prescription pads can be issued to new OAT prescribers.

Enhanced Skills Training *Link*
Offered in partnership with the University of British Columbia (UBC) Family Medicine Enhanced Skills Program (Category 2) this 3-6 month program is for primary care providers currently in practice to improve their knowledge and skills in the area of addiction medicine. The program provides hands-on clinical learning opportunities across the range of inpatient and outpatient addiction medicine venues. A customized curriculum can be developed to support individual learners needs.

BC ECHO on Substance Use *Link*
The BC ECHO on Substance Use (Opiod Use Disorder) supports primary care providers in BC and Yukon Territory to build capacity in the clinical management of OUD in their practice. ECHO links providers using an interactive, web-based platform to a core interdisciplinary team with expertise in managing OUD. Free and CME accredited (Mainpro+ and MOC Section 1).

Buprenorphine-naloxone (Suboxone®) *Link*
Thirty-minute Learning Hub course to provide health care providers and patients with an understanding of buprenorphine-naloxone (Suboxone) pharmacology and use.


Flexible and Enhanced Learning (FLEX) *Link*
The BCCSU FLEX projects are open to current medical students enrolled at UBC as a part of their Flexible and Enhanced Learning (FLEX) curriculum. They have been designed for highly motivated students who are interested in potentially pursuing a career in addiction medicine and/or epidemiology research. The FLEX Project is open to students at any site but must be completed onsite at St. Paul’s Hospital in Vancouver.

Interdisciplinary Fellowship Program *Link*
The BCCSU Fellowship programs are multidisciplinary and strive for excellence in clinical training, scholarship, research, and advocacy and includes specialty training in inpatient and outpatient addiction management, as well as related concurrent disorders training. It prepares Fellows to work as experts in the field of substance use
and take leadership roles in clinical, academic, and/or research settings.



Equipping for Equity Online Modules *Link*
This free online training is for emergency department and primary health care staff to provide equity-oriented care, particularly for marginalized populations. EQUIP’s take on Equity-Oriented Health Care incorporates the three key dimensions: trauma- and violence-informed care, culturally-safe care and harm reduction.

Opioids: A Survivor’s Guide *PDF*
A Survivors Guide handbook was written by a group of people from around British Columbia (BC) who together, have years of experience using opioids and other street drugs, with support and funding from the BCCSU.

Moments to Milestones: Engaging with People who use Substances *Link*
Thirty-minute video developed by Fraser Health to highlight the positive difference that respect, compassion and inclusion can make when working with people who use substances.

Respectful Language and Stigma Regarding People Who Use Substances *PDF*
Short document developed in BC that outlines stigma, how stigma influences health and recommendations for change.


Language Matters Poster *JPG*
Poster with clear examples of how to use person-first language when discussing addiction.

PEER Engagement Principles and Best Practices *PDF*
A guide for BC Health Authorities and other providers to meaningfully engage peers in health service planning and policy making.

The Context Experts *PDF*
This short guide from the Tamarack Institute discusses the ‘why’ and ‘how’ of meaningfully involving community members who are the true context experts.

Engaging Individuals with Lived Experience *PDF*
This resource from Alberta offers a framework for respectfully and meaningfully engaging patients, families and others with lived and living experience.

“Nothing About Us Without Us” Greater, Meaningful Involvement of People Who Use Illegal Drugs: A Public Health, Ethical and Human Rights Imperative *PDF*
This case study dives into the meaningful involvement of people who use drugs through an examination two organizations: the Vancouver Area Network of Drug Users and the Thai Drugs Users’ Network.

Crackdown Podcast *Link*
This podcast is led by an editorial board made up of some of Vancouver’s most experienced drug user activists. CRACKDOWN is produced by Cited Media Productions on the territories of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), and sel̓íl̓witulh (Tsleil-waututh) Nations.


OAT Clinics Accepting New Patients *Link*
List of OAT clinics across BC that are currently accepting new patients. Provided and updated by the BC Center on Substance Use.

Substance Use Journey Maps *Link*
This series of journey maps provide a visual illustration of the experience of patients and providers engaging in substance use care.


Project Inclusion: Confronting Anti-Homeless and Anti-Substance User Stigma in British Columbia*Link*
Full report (132 pages) by PIVOT Legal Society on the legal, policy-related and other structural barriers that must be addressed in order to meaningfully prevent opioid-related deaths.

BCCSU List of Common Acronyms & Glossary *PDF*
A quick guide to common terms for discussing substance use care.

Opioid Agonist Treatment: General Information *PDF*
This handout from the BC Center on Substance Use provides general information on OAT, OAT medications and how OAT programs work in BC. 

Frequently Asked Questions about Opioid Agonist Treatment *PDF*
This handout from the BC Center on Substance Use provides answers to some common questions service operators may have about OAT and accommodating clients taking OAT in supportive recovery settings. 

Roles and Responsibilities: Supporting Clients on OAT *PDF*
This handout on the BC Center on Substance Use summarizes the different roles and responsibilities that service operators, clients, and OAT prescribers/teams have in working together to support clients on OAT in supportive recovery settings. Additional resources are also provided on OAT and opioid use disorder. 

Effective Strategies for Hospitals Responding to the Opioid Crisis *PDF*
Report from the Institute for Healthcare Improvement that outlines system-level strategies that hospitals can implement immediately to address the challenges of preventing, identifying, and treating opioid use disorder. 

ED-Initiated Buprenorphine *Link*
This website by the Yale School of Medicine includes resources such as clinical evidence and strategies for motivating patients. 


Culture Change Toolbox
A collection of tools and interventions for changing culture, each one accompanied by tips on how to apply it.

ATTIC: Activities for Transforming Teams & Igniting Change
ATTIC is a collection of activities that you and your team can use to build teamwork, develop communication skills, enable creative thinking and innovation, and help explore systems.

A Guide to Patient Engagement
This BCPSQC resource covers the essentials of patient engagement, how to prepare for it, where you can find patient partners and how to engage them.