er missing opportunity to send overdose patients to addiction treatment

ERs Missing Opportunity to Send OD Patients on to Addiction Treatment

In spite of the current opioid crisis that has been making headlines on a regular basis, Emergency Room (ER) doctors and staff have been missing opportunities to refer overdose patients to addiction treatment. The results of a recent study conducted on Medicaid claims in West Virginia indicate the health care system “doesn’t seem to be set up” for referring patients to further help.

Hospital Codes for Opioid Poisoning Examined During Study

The researchers examined insurance claims made for 301 people who overdosed in the years 2014 and 2015. By analyzing the hospital codes used for opioid poisoning, they were able to follow the treatment the patients received. The researchers were specifically looking to see whether the patients were billed in the months following their ER visit for health care services such as:

  • Counseling or mental health care
  • Opioid counseling visits
  • Prescriptions for psychiatric drugs (anti-depressants, anxiety medications, etc.)
  • Prescriptions for substance abuse medications

As a result of their work, the researchers found that less than 10 percent of the patients received (per month) substance abuse medications such as buprenorphine. Since methadone isn’t covered by West Virginia Medicaid, it wasn’t included in the study.

In the month the overdose occurred, about 15 percent of the patients received mental health counseling. In the 12 months after the overdose, that number had dropped to lower than 10 percent of patients per month.

Researchers Expected More Addiction Treatment for Overdose Patients

Neel Koyawala, a second-year medical student at Johns Hopkins School of Medicine in Baltimore, the lead author of the study, said that the researchers “had expected more…especially given the national news about opioid abuse.”

Andrew Kolodny, the co-director of Opioid Policy Research at the Heller School for Social Policy and Management at Brandeis University, said that resources should be focused on getting patients who have experienced nonfatal overdoses into treatment.

He compared the situation to someone coming into the ER with a heart attack. Patients and their families take for granted that heart medication and a referral to a cardiologist will be provided when the patient is discharged. Kolodny wants to see patients who come to the ER with an overdose to get started on buprenorphine in the hospital and receive a referral to some type of addiction treatment when they leave.

Both Kolodny and Koyawala point to a combination of lack of training and understanding among health care professionals for what continues to happen to overdose patients after they are stabilized.

Dr. Matt Christiansen, an assistant professor at Marshall University Joan C. Edwards School of Medicine’s Department of Family & Community Health, stated that [a substance abuse patient’s] risk of overdose is the same the day after as it was on the day of an overdose.