The Drug Enforcement Administration’s recently released 2018 National Drug Threat Assessment estimates that opioids killed roughly 200 people a day in 2017. Despite efforts across the country to halt the national opioid epidemic, we continue to see deaths.
Hospital-based physicians have a unique opportunity to identify innovative programs and proven practices that prevent and treat addiction in isolated pockets of the healthcare system and bring them to scale.
As a practicing emergency physician, I’ve witnessed the opioid crisis first hand. Emergency departments (ED) across the country are experts in pain management; the most common presenting symptom among ED patients is pain. In hospitals across the country, emergency departments are making strides to prevent opioid addiction by identifying alternative pain treatment options and identifying at-risk patients who need addiction treatment resources.
New legislation such as the recently passed and signed bipartisan Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) highlight and encourage these approaches.
This is just the beginning of our journey as hospital-based physicians. Emergency physicians and hospitalist medicine physicians are exploring collaboration on best pain management practices for those admitted to the hospital. We are exploring how addiction treatment resources can begin or be connected to the public health resources in our communities. Anesthesiologists prepare patients for surgery and pain and addiction specialists help patients cope with chronic pain, and also provide expertise and resources to our hospitals and outpatient clinics.
Even in neonatal intensive care units, nurses and physicians are working together to combat the opioid epidemic. Opioid abuse during pregnancy has risen dramatically in recent years, contributing to a spike in opioid-dependent neonatal patients and Neonatal Abstinence Syndrome (NAS).
Clinicians caring for newborn babies play a critical role teaching parents how to care for infants with NAS and encouraging evidence-based practices, such as rooming-in and breastfeeding, that have been shown to improve outcomes and decrease length of stay for this vulnerable patient population. And with an eye to prevention, providers caring for pregnant women are seeking training to identify at-risk patients and help them get counseling and treatment.
Unquestionably, clinicians across the healthcare system are delivering high-quality care to prevent addiction and to help patients and families who are struggling with substance use disorders. Yet we can do more to learn from each other. Efforts such as white papers, state- and federal-funded pilot programs and industry gatherings can further improve patient outcomes by enabling clinicians to share appropriate interventions, innovative pain management plans and effective behavioral health resources.
Organized medicine associations are leading the way by disseminating best practices to ensure clinicians are equipped to leverage their knowledge and skills to prevent and treat addiction. As an example, the Society of Hospital Medicine’s Reduce Adverse Drug Events related to Opioids (RADEO) guide details protocols to help hospital medicine specialists implement safe opioid therapies.
The American College of Emergency Physicians has an Innovation grant entitled "EQUAL" from the Centers for Medicare and Medicaid Services. One of EQUAL’s focuses is to collect data, educate, and recollect data on alternatives to opioid treatment programs and addiction support. Similarly, the American Society of Anesthesiologists launched a national pilot called the Safer Postoperative Pain Management program to educate patients and families on safe opioid use, storage and disposal.
Innovations like these are making an impact yet too many of them are isolated by institutional, geographic or other barriers. Federal agencies are funding programs such as the Helping to End Addiction Long-term Initiative to break down barriers between the healthcare system, behavioral health providers, justice systems, state and local governments and community organizations. These programs set the collaborative, unified example that we, as hospital-based clinicians and health system leaders, must follow.
As the Office of the Surgeon General cautions, "When healthcare is not well integrated and coordinated across systems, too many patients fall through the cracks, leading to missed opportunities for prevention and early intervention, ineffective referrals, incomplete treatment, high rates of hospital and emergency department readmissions, and individual tragedies (e.g., opioid overdoses) that could have been prevented.”
Let’s use every resource we have as medical professionals to put an end to this national epidemic. It is incumbent on us to break down the barriers between silos of the medical community and help clinicians work together to be part of the solution.
Dr. Rebecca Parker is a board-certified emergency medicine physician. She serves as chief of medical affairs for Envision Physician Services and is a former president of the American College of Emergency Physicians.