Opioid Overdoses Challenge ERs


Every day, there is a new story about the opioid epidemic in the U.S. Front-page headlines tout everything from President Donald Trump’s call to impose a death penalty on drug dealers to state and local governments suing drugmakers who supply the medications.

The statistics are chilling: In 2016, 63,632 people died from drug overdoses, the Centers for Disease Control and Prevention estimated. That was a nearly 30 percent jump over 2015. Most of the attention correctly is focused on education and prevention.

But I began wondering what medical professionals are doing to address opioid addiction, beyond cutting back on the number of narcotics they prescribe. I talked with three doctors who are on the front lines, treating addiction-related overdoses in hospital emergency rooms.

ERs play a critical role in fighting the opioid crisis, as they’re often the first place people needing addiction treatment go, they told me. Studies also have shown that many people who go to ERs for treatment of other injuries and illnesses have a high rate of substance abuse.

The doctors, along with several attorneys, told me they don’t think there’s a need to modify the federal law that sets out requirements for emergency rooms, the Emergency Medical Treatment and Labor Act. None of them are seeing evidence that hospital ERs are shirking their duties to appropriately screen and stabilize overdose patients before discharging or transferring them.

But all of the doctors think there is more that can be done. They pointed, for example, to a Boston pilot program that puts substance abuse counselors—who can screen for substance abuse and help people get into effective treatment programs—right in the ERs.

In rural areas, or those where there are fewer resources, telehealth could prove an effective way to get this counseling to at-risk ER patients, one doctor said. Developing a system to keep overdose patients in ERs longer, such as creating a “crisis” bed, may help avoid repeat overdoses, he said.

The physicians also favor more training and education for doctors. In contrast to other specialties, there are only a few thousand physicians who are board-certified in addiction treatment. They would like to see that change.

The medical profession needs to recognize addiction as a chronic disease and develop policies and procedures for evidence-based treatment on the same level as any other chronic disease, they said.

To read more about the doctors’ recommendations, go to my story here.

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