Sinai Health researcher launches emergency department guidelines for managing alcohol-related disorders

At Sinai Health, researchers have launched the first clinical guidelines for emergency department physicians to manage non-opioid use disorders, with a focus on alcohol withdrawal syndrome, alcohol use disorder and cannabinoid hyperemesis syndrome.

“Alcohol-related problems are excessive and extremely common,” said the lead author of the study Dr. Bjug Borgundvaag, Emergency Medicine Physician and Director of the Schwartz/Reisman Emergency Medicine Institute (SREMI), a not-for-profit focused on improving emergency care in Canada and beyond. “These problems are common in all emergency departments and it is important that emergency providers are aware of, and know how to apply the best evidence for managing them.”

According to the Centre for Addiction and Mental Health, nearly 18 per cent of people aged 15 years or older in Canada will meet the clinical criteria for an alcohol use disorder in their lifetime, and over 50 per cent of people in Canada aged 15 years or older currently drink more than the amount recommended in Canada’s guidance on alcohol and health.

Despite the high prevalence of high-risk drinking and alcohol use disorder, these conditions frequently go unrecognized and untreated in the health-care system. Even if recognized, people with alcohol use disorder often end up being treated by emergency physicians who do not have the tools necessary to handle such cases.

The study was sponsored by the Society for Academic Emergency Medicine (SAEM) as part of a series of clinical guidelines entitled GRACE—guidelines for reasonable and appropriate care in the emergency department. The program addresses the best practices for the care of the most common chief complaints that can be seen in the emergency department.

A diverse panel of emergency physicians, clinicians, scientists, and toxicologists collaborated with patient stakeholders to review all the available evidence concerning adults presenting with alcohol withdrawal syndrome and alcohol use disorder in the emergency department and summarize it in concise guidelines for practicing emergency physicians.

In addition to the guidelines, the panel urges emergency room physicians to prescribe specific medications to patients experiencing severe alcohol withdrawal symptoms from heavy use of alcohol.

In an interview with the Canadian Press, Dr. Borgundvaag commented that the usual medication for moderate to severe alcohol withdrawal syndrome is diazepam, which is sold under the brand name Valium. Instead, the experts recommended phenobarbital along with benzodiazepines, compared to benzodiazepines alone.

Some physicians are not familiar with phenobarbital because it’s an older drug, but it should be prescribed to patients who will likely be hospitalized, sometimes in an intensive care unit, for symptoms associated with withdrawal, noted Dr. Borgundvaag.

Dr. Borgundvaag and his team will be presenting the guidelines at conferences and rounds to promote awareness of the findings and to translate this knowledge into action. He hopes the study will raise awareness and interest in these conditions and that people will use the guidelines as a starting point for new research to expand or revise on the recommendations.