South Florida Hospital News
Monday May 21, 2018
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February 2018 - Volume 14 - Issue 8

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Opioid Overdose: An Expanded Role for Hospitals

Eighty percent of the world’s opioid supply is consumed in the United States. Over 97 million Americans took prescription painkillers in 2015, and 12 million of those people did so without the direction of a physician. The opioid crisis sweeping the country continues to grow, so hospitals and ERs are increasingly confronted by this ongoing epidemic.

According to the CDC, last year the United States saw more than 63,000 people die of drug-related overdoses, and in 2015, roughly one in every 50 deaths was drug-related. For every fatal overdose, there were as many as 25 ER visits. In addition to seeing increasing numbers of patients needing treatment for overdose, the patients seeking care are sicker and more complicated to treat than in the past.
 
The White House Council of Economic Advisers reported that, in 2015, the opioid epidemic cost the United States economy over $500 billion, and a study by Beth Israel Deaconess Medical Center in Boston put the cost of treating opioid overdoses at 58% higher than it was a decade ago. This increase is due in large part to the fact that treatment of overdoses is resulting in higher survival rates driven by the availability and utilization of naloxone products.
 
Receiving treatment in an ER, however, can provide an opportunity to positively impact mortality for overdose survivors while also reducing both direct and indirect healthcare costs. Commonly, victims of opioid overdose are treated with naloxone in the ER and following hospital admission, if required, are discharged home with a referral for substance abuse treatment. Some ERs do also provide SBIRT (Screening and Brief Intervention) to patients following overdose.
 
In many cases, however, referrals to treatment alone do not result in treatment engagement, and SBIRT has shown mixed results in this patient population. The lack of follow-up treatment allows a chronic, progressive disease such as opioid use disorder to worsen. Brigham and Women’s Hospital estimates that nearly 94% of overdose victims treated with naloxone in the ER survive the initial overdose. However, they remain at risk for further overdose if they do not receive appropriate follow-up treatment for their opioid use disorder. As many as 10% of those who survive an opioid overdose will die of subsequent overdose within one year, with the highest risk being within the first two weeks following overdose.
 
Several strategies are being examined in an effort to improve treatment engagement following opioid overdose. In Montgomery County Pennsylvania, emergency rooms have partnered with local substance abuse treatment facilities to provide a “warm hand-off” for survivors of opioid overdose. Rather than simply being referred for follow-up treatment, a substance abuse treatment clinician engages with the patient while still in the ER and can help facilitate direct transfer into inpatient substance abuse treatment. Early experiences have demonstrated some success in improving patient engagement with follow-up treatment while reducing the immediate risk of repeated opioid overdose.
 
The feasibility of initiating medication to treat opioid use disorder while the patient is in the ER is also being investigated. Dr. Gail D’Onofrio, an ER physician at Yale University, recently published a study where patients in the ER were given buprenorphine, an effective partial-opioid agonist approved for the treatment of opioid use disorder. After one month, patients who received buprenorphine were twice as likely to still be engaged in treatment, and the treatment was found to be more cost-effective when compared to opioid overdose survivors who were simply given a referral to follow-up care.
 
Hospitals and ERs have an increasingly important role in addressing the current opioid epidemic. In addition to the successful treatment of opioid overdose, expanded relationships with substance abuse treatment providers and implementation of maintenance medications may help to improve the prognosis for this patient population. These relationships should evolve as opioid use continues to grow across the country.

By Michael Frost, MD, FASAM, is the Corporate Medical Advisor for Sunspire Health.

 
For more information, contact Sandra Laffler at (561) 237-1615 or email SLaffler@sunspirehealth.com.
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