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What can we learn from buprenorphine precipitated withdrawal in the ED/hospital? A 🧵 @AustinKilaru @JMPerroneMD @kit_delgadoMD @m_lowenstein @especially_APT @JACEPOpen @NIDAnews @PennMedicine #emergencymedicine #toxtwitter 
#1 Check those COWS Scores. 4 out of 13 cases of PW, got bupe for COWS scores of less than 8 (see below). Also important to check COWS scores shortly after getting bupe to make sure they are actually getting better. Great place for ordersets to improve care
#2 PW from traditional bupe inductions is real! Definitely a concern in the fentanyl era. We had patients develop PW after greater than 12 hours (sometimes even longer) since last opioid use. people who use fentanyl might be at higher risk
