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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.

Opioids for ER Patients

Over-the-Counter Pain Relievers as Effective as Opioids for ER Patients

For a number of patients, their first introduction to opioid pain medications occurs when they seek treatment in an Emergency Room (ER). Since doctors have more than one option for treating pain, what would happen if they offered over-the-counter pain medications instead of these strong, potentially addictive drugs instead?

A new study looked at what would happen if doctors took this approach to patients who visited the ER for treatment of sprains and broken bones. The results found that pain relievers sold under brand names as Tylenol and Motrin were as effective as opioids for treating severe pain.

Treating Acute Pain Without Opioids

The study involved 411 adult patients who sought treatment in two Emergency Rooms in New York City. All of them received ibuprofen (the main ingredient in Motrin) and acetaminophen (the main ingredient in Tylenol) or one of three opioid drugs: codeine, oxycodone or hydrocodone. All patients received standard doses, and none were told which medication was being administered.

The patients rated their pain levels on a score of 1-10 before being given their pain medication and again two hours later. The researchers found that for an average patient, the pain levels dropped from a 9/10 to approximately 5/10. There was little difference reported between the two groups.

Dr. Andrew Chang, Professor of Emergency Room Medicine at Albany Medical College in New York State, explained that ibuprofen and acetaminophen affect different pain receptors in the body. He went on to say that using them together may be especially effective.

These results dispute the standard ER practice used for treating acute pain. It could lead to changes that could help prevent new patients from being given opioids, which have such a high potential for abuse.

Although the study didn’t continue to follow the patients after they left the hospital, it is likely that the pain relief continued while taking the OTC remedies.

Study Has Potential to Help Opioid Crisis

Over two million people in the US are addicted to prescription painkillers or heroin. According to experts, changes in how ER doctors prescribe drugs could potentially put a dent in the current opioid crisis and help save lives.

Long-term opioid use often starts after patients are introduced to the drugs in an acute pain treatment situation. Emergency Rooms have given them to patients more often in recent years, although more states have limited the number of pills that can be given out. According to previous studies, approximately one-third of ER patients received an opioid painkiller during their visit. Approximately 20 percent of ER patients leave the hospital with a prescription for an opioid pain medication.