Friday, 16 Nov 2018
News

In the face of an overdose epidemic, some emergency surgeries are now offering treatment for addiction.


For Zachary Dezman, an emergency physician in Baltimore, a city infested with heroin, there is no doubt that offering drugs for addiction to emergency room patients is the right thing to do. Drug addicts are generally in poorer health than the rest of the population, he said. "These patients are marginalized from the health system. We see people every day who have nowhere to go. "If they need drugs for addiction – and many of them – why do not we give them to emergencies?" We give them medicine for every other life-threatening illness. But elsewhere in the country, only a few emergency physicians and hospital administrators see things differently. They are concerned that drug treatment services may attract more drug-seeking patients than they have ever seen, taking up valuable time and staff beds. said Andrew Kolodny, co – director of the opioid policy research group at Brandeis University. Instead of providing anti-addiction drugs, many hospitals are giving patients with drug-related emergencies phone numbers from local treatment clinics, he said. Despite an overdose epidemic that kills nearly 200 Americans every day and sends thousands more to emergencies, the vast majority of the more than 5,500 hospitals in the country have so far avoided offering drug addiction drugs to patients emergency. It's starting to change. In the Dezman Emergency Department at the Midtown Campus of the University of Maryland Medical Center in West Baltimore – and at 10 other Maryland hospitals – drug treatment services, including the treatment of patients with buprenorphine, are new and growing emergency services. Similar services are planned for emergency services at 18 other Maryland hospitals, said Marla Oros, president of Mosaic Group, a management consulting firm that provides technical assistance to state hospitals. Approved by the Food and Drug Administration in 2002 for the treatment of opioid addiction, buprenorphine has been shown to be over twice as effective as non-drug treatments to help opioid users quit smoking . Taken daily orally, the narcotic eliminates withdrawal symptoms and drug cravings, allowing users to feel normal without producing side effects. A 2017 study by researchers at the Yale School of Medicine found that opioid-addicted patients who received an initial dose of buprenorphine were twice as likely to receive treatment a month later than those receiving only one dose of buprenorphine. addiction treatment. specialists. Nevertheless, a survey conducted in 2017 by the American College of Emergency Physicians showed that only 5% of emergency physicians work in hospitals offering buprenorphine or methadone, an addictive medication, and 57% said that drug treatment and addiction treatment facilities outside the hospital were "rare". or never accessible. Eric Weintraub, an associate professor of psychiatry at the University of Maryland's School of Medicine, was one of the first to adopt buprenorphine in emergencies and now helps spread the concept in others. hospitals. From 2003, he initiated buprenorphine patients in a psychiatric emergency department at the University of Maryland Medical Center in downtown Baltimore, and said he was effective in enabling patients to to feel normal again and to start thinking about treatment. In an interview, Weintraub said, "We have learned that some places are conducive to patient participation in treatment. One of them is the ER. The other is the criminal justice system. We must seize these opportunities and offer patients effective treatment when they are ready. One Monday in September, the morning is stormy, Midtown campus emergencies are calm. Dezman takes a look at the automatic glass doors at the entrance and explains that a wave of victims of an overdose could begin arriving at any time. "That's the way it usually happens," he said. "EMS will tell us that four people were found within a radius of two streets and two others were found dead nearby. It's almost always because of a bad lot of fentanyl. On average, about 70 people go to Midtown Campus emergencies every day, and two or more are present due to an overdose. "If someone had to enter now or at any time before 4 pm and need treatment, the emergency staff will review them and probably send them to the other side of the room. the street at the hospital's addiction treatment center. Outside office hours, when treatment facilities are generally closed, emergency staff give patients who wish to have their first oral dose of buprenorphine. Hold them for an hour or two to watch them and make an appointment for them with a treatment center for the next morning, said Dezman. Dezman has a special license from the Drug Enforcement Administration allowing him to prescribe buprenorphine, a narcotic. Most emergency physicians do not have a buprenorphine prescription license and Oros said they did not want to complete the eight hours of clinical training required to obtain it. Under the three-day rule, unlicensed DEA physicians can administer a single dose of the drug to a patient within 72 hours. As a result, any of the Midtown Campus Emergency Physicians can start delivering the potentially vital medication and work with a recovery coach to motivate patients to go to a treatment center to receive their second dose and the following daily doses. Once patients are stabilized, they can get a monthly prescription for the drug against addiction from any primary health care physician holding a DEA license. In 2016, drug and alcohol overdose deaths in the state of Maryland increased by two-thirds to more than 2,000. So, for Maryland hospitals, it made financial sense to help the most. people can cope with their addiction so that they are no longer forced to report to their emergency services, Oros said. Although the stigma associated with addiction is beginning to diminish among the general public, emergency physicians and nurses are seeing the worst of drug addicts, and many do not want to have anything to do with them. Hospital administrators also consider that drug addicts pose a low insurance risk in states that have not yet expanded Medicaid, he said. "But if this movement in Maryland and other states succeeds and begins to normalize nationwide, it could change everything," Kolodny said. "If you really want overdose deaths to go down in the United States, buprenorphine treatment should be easier and cheaper for people with substance use disorders than having them." Heroin and other opioids on the street. And what is easier than entering an emergency room and starting to take buprenorphine? Stateline Stateline is an initiative of the Pew Charitable Trusts. Read more An overdose showing the dangers of powerful synthetic drugs Prisons slow to deliver drugs that reduce inmate cravings San Francisco will offer anti-addiction drugs to street users.

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