Resources for the treatment of substance use disorders from the acute care setting

Emergency Department Resources



Safer Prescribing from the ED

Between 1997 and 2007 the use of prescription opioids more than quadrupled. Similarly, drug overdose deaths significantly increased for the 11th consecutive year in 2010. Although emergency physicians manage 28% of all acute care visits in the United States, only 5% of all opioid prescriptions are written by emergency physicians. As leaders in health care we are empowered do our part in reversing this alarming public health trend.

California ACEP has endorsed and is promoting the following safe prescribing guidelines that were updated in October 2018 and supported by numerous partners.

Safe pain medicine prescribing (English)

Safe pain medicine prescribing (Spanish)

How to talk to patients about safe prescribing

Helpful prescribing tips


1. Talk with your pharmacy director to be sure that buprenorphine is on the hospital formulary

2. Develop a connection and with an outpatient facility who can receive patients referred from the ED.

3. Train nurses and doctors how to assess opioid withdrawal severity and how to dose buprenorphine. 

4. Create or adapt a simple guide for providers for use in the clinical areas for real-time consultation.

5. If possible, bring in a substance use navigator to help patients transition to outpatient care.

6. Obtain patient education materials from outpatient partners that describe how to access their buprenorphine treatment services.


PLEASE VISIT for more resources related to treatment of substance use disorders in the emergency department setting

Inpatient Resources

Resources to treat substance use disorders from the inpatient setting

This toolkit was developed by an interdisciplinary team based on published evidence and expert opinion. As the literature develops best practices may change. They should never be used as a substitute for clinical judgement.

Individual providers are responsible for assessing the unique circumstances and needs of each case. Adherence to these guidelines will not ensure successful treatment in every situation.

This information is intended for healthcare providers and subject matter experts, it is not intended for use by patients and the general population. These clinical practice guidelines do not set a standard of care, rather they are an educational aid to practice. They do not set a single best course of management, nor do they include all available management options.


Treatment Guidelines for the Inpatient Setting

  • Buprenorphine


Data 2000 X-Waiver Training


Under the Drug Addiction Treatment Act of 2000 (DATA 2000), physicians are required to complete an eight-hour training to qualify for a waiver to prescribe and dispense buprenorphine.  Find information about the eight-hour buprenorphine waiver training courses that are required for physicians to prescribe and dispense buprenorphine.

Harm Reduction

Promoting the health of those with substance use disorders



A step-by-step illustrated guide on how to use a naloxone kit in the event of an overdose.


Harm Reduction Coalition is a national advocacy and capacity-building organization that works to promote the health and dignity of individuals and communities who are impacted by drug use.


Clinical Support

clinician to clinician support to start medication for substance use disorders


California Poison Control Hotline:


Ask for “Buprenorphine bridge start help”



Bup-Bridge Direct Line:



The California Poison Control System now offers 24/7 support for Emergency Department clinicians to discuss buprenorphine starts.

The California Poison Control System can help you with:

  • Identification of opioid withdrawal

  • Dosing of buprenorphine to treat opioid withdrawal

  • Solutions or troubleshooting a plan to bridge patients to outpatient buprenorphine maintenance therapy

  • Treatment of opioid withdrawal in special populations (e.g. pregnancy, pediatrics)

  • Treatment of precipitated withdrawal

  • Treatment of patients with other underlying toxicological conditions

Poison control agencies are not covered entities pursuant to HIPAA (i.e. CPCS is HIPAA exempt).

The California Poison Control System’s Buprenorphine-Bridge line can be reached directly at 415-643-3257.  If calling from the California Poison Control System's main hotline at 1-800-222-1222, please ask for “Buprenorphine bridge start help” for assistance with management of opioid withdrawal.  Please note that callers (ED providers) may be contacted at a later time for a follow-up survey. 



UCSF Substance Use Warmline:


From 6am-5pm (Monday-Friday), non-urgent consultation requests may be directed to addiction-certified physicians or clinical pharmacists who can provide same-day responses.

The Warmline is open to questions from internal medicine, surgery, pharmacy, anesthesia, primary care/other ambulatory, obstetrics/women’s health practices, and other specialty care.

The Warmline can help with issues related to any substance use disorder (i.e. not only opioids), the safety profile of buprenorphine dosing, pharmacy protocols related to buprenorphine and naloxone, buprenorphine dosing algorithms and guidelines, comorbid pain, toxicology testing, and any other addiction issues.  Specialty expertise is also available for patients with (or at high risk for) HIV and viral hepatitis.

Callers may be contacted for a follow-up survey.

Consultation requests may also be submitted online at:  


Policy Resources

OVERCOMING DATA-SHARING CHALLENGES IN THE OPIOID EPIDEMIC: Integrating Substance Use Disorder Treatment in Primary Care 

(July 2018) In response to the opioid epidemic, states and the federal government have sought to increase the availability of substance use disorder (SUD) treatment. Through medication-assisted treatment (MAT) programs and other efforts, primary care practices have taken a more prominent role in providing SUD care. Primary care practices are stepping up to treat addiction due to many factors — recognition of the role of the medical system in driving opioid overuse and addiction, shifting of attitudes about addiction with acceptance of SUD as a chronic disease, and insufficient specialized treatment resources to address growing demands, especially in rural areas. However, common roadblocks for primary care practices are the inability to efficiently and effectively communicate with SUD providers and a lack of clear guidance about how to share SUD and primary care treatment information.


(June 2018) The Urban Institute – This report provides a rapid review of evidence on the potential cost savings associated with providing screening, brief intervention, and referral to treatment for individuals with substance use disorders (SUDs) related to alcohol and drug use in emergency departments (EDs).