Tag: emergency rooms

Emergency Rooms Are Failing Overdose Victims, Study Shows

Fewer than 10% of people who were treated in West Virginia emergency rooms for non-fatal overdose were connected with medication-assisted treatment.

When people show up in the emergency room, they expect not only to be treated for the immediate problem, but to be connected with ongoing care. Someone with a broken arm, for example, can expect to have it set and leave with a referral to an orthopedist.

Yet, this system is failing people with substance use disorder, one of the most deadly medical conditions in the country.

According to a new study published in the Journal of General Internal Medicine, fewer than 10% of people who were treated in West Virginia emergency rooms for non-fatal overdose were connected with medication-assisted treatment, and just 15% were connected with counseling.

Although the study looked at just one state, the findings are symptomatic of failures in the medical system across the country, Andrew Kolodny, who directs opioid policy research at at Brandeis University’s Heller School for Social Policy and Management, told California Healthline.

He said, “There’s a lot of evidence that we’re failing to take advantage of this low-hanging fruit with individuals who have experienced a nonfatal overdose. We should be focusing resources on that population. We should be doing everything we can to get them plugged into treatment.”

Even the researchers were surprised by the low rates of ongoing treatment for opioid use disorder for patients who were clearly in need of treatment, said lead study author Neel Koyawala, a student at the Johns Hopkins School of Medicine.

“We expected more… especially given the national news about opioid abuse,” Koyawala said.

Dr. Margaret Jarvis, who works as medical director of a residential addiction treatment center, said that despite the prevalence of addiction, emergency room doctors often don’t know how to help people who present with substance use disorder.

“Our colleagues in emergency rooms are not particularly well-trained to be able to help people in a situation like this,” she said. Marissa Angerer visited the emergency department in Texas many times with substance abuse-related conditions. She was never offered ongoing intervention and was surprised when doctors didn’t understand what she meant when she said she was dopesick.

“They were completely unaware of so much, and it completely blew my mind,” she said.

When Angerer finally got into recovery, it was because she found a treatment center herself after having fingers and toes amputated because of an opioid-related condition.

“There were a lot of times I could have gone down a better path, and I fell through the cracks,” she said.

View the original article at thefix.com

23 February 2019
More ERs Are Providing Withdrawal Meds As First Step To Recovery

Patients in need are receiving buprenorphine to address their withdrawal symptoms.

Kicking an opioid habit comes with a host of physical withdrawal symptoms so severe that people often end up in the emergency room.

There, they are usually treated for diarrhea or vomiting, but not the underlying issue. Now, however, more emergency rooms around the county are providing buprenorphine to help ease withdrawal and get more people into treatment.

“With a single ER visit we can provide 24 to 48 hours of withdrawal suppression, as well as suppression of cravings,” Dr. Andrew Herring, an emergency medicine specialist at Highland Hospital in Oakland, California, told The New York Times.

At Highland, people who come in presenting with withdrawal symptoms are given a dose of buprenorphine, also known as Suboxone, and are told to follow up with Herring, who runs the hospital’s buprenorphine program.

“It can be this revelatory moment for people—even in the depth of crisis, in the middle of the night,” Herring said. “It shows them there’s a pathway back to feeling normal.”

Although the Drug Enforcement Administration (DEA) requires doctors to receive special training and a license to prescribe buprenorphine, doctors in the ER can provide the medication without this training. Still, Herring said, many healthcare providers hesitate to provide the first step toward medication-assisted treatment (MAT).

“At first it seemed so alien and far-fetched,” he said.

Yet, research into the practice is promising. A 2015 study showed that people who were given buprenorphine in the ER were twice as likely to be in treatment 30 days later than those who were not given medication to help with withdrawal.

“I think we’re at the stage now where emergency docs are saying, ‘I’ve got to do something,’” said Dr. Gail D’Onofrio, lead study author. “They’re beyond thinking they can just be a revolving door.”

California has plans to expand treatment for withdrawal in emergency rooms, using $78 million in federal funding to establish a hub-and-spoke system where people would get their first dose of medication in the emergency room before being connected with ongoing services.

Dr. Kelly Pfeifer, director of high-value care at the California Health Care Foundation, said this is the next step in providing quality care for people fighting addiction.

“We don’t think twice about someone having a heart attack, getting stabilized in the emergency department, and then getting ongoing care from the cardiologist,” she said. “And the risk of death within a year after an overdose is greater than it is for a heart attack.”

View the original article at thefix.com

22 August 2018
Could Ketamine Replace Opioids In The ER?

A new study examined whether ketamine could work as an alternative to opioids for pain relief in an emergency room setting.

Ketamine could be a viable option for acute pain relief, working at least as well as morphine, according to a new medical review.

“Ketamine appears to be a legitimate and safe alternative to opioids for treating acute pain in the emergency department. Emergency physicians can feel comfortable using it instead of opioids,” Dr. Evan Schwarz, senior study author, said according to Medical News Today.

Schwarz led a team of researchers from the Washington University School of Medicine in St. Louis who reviewed the experience of 261 patients who were given only ketamine to treat their pain in the emergency room.

The researchers found that ketamine was as effective as morphine for pain relief. There were no severe adverse affects reported, although ketamine did have a higher instance of minor adverse affects. Overall, however, the study authors concluded that ketamine is an effective pain relief tool.

“Ketamine is noninferior to morphine for the control of acute pain, indicating that ketamine can be considered as an alternative to opioids for ED short‐term pain control,” study authors wrote.

Ketamine, which is a well-known party drug, was approved for medical use by the Food and Drug Administration (FDA) in 1970. Since then it has been used as an anesthetic. It is also sometimes used in conjunction with opioids for pain relief. However, the new study indicates that low-dose ketamine can provide pain relief even when it is used alone.

With more healthcare providers looking for alternative pain treatments that do not involve opioids, this is a promising finding. Ketamine is not addictive and does not cause respiratory depression, two conditions that are the main risk factors when using opioids to treat pain, particularly in older patients.

The study looked at a relatively small number of patients. However, authors said that its findings indicate that more research is needed into using ketamine as a potentially safer pain-relief option for acute pain.

“Opioids are commonly prescribed in the emergency department (ED) for the treatment of acute pain,” study authors wrote. “Analgesic alternatives are being explored in response to an epidemic of opioid misuse. Low‐dose ketamine (LDK) is one opioid alternative for the treatment of acute pain in the ED.”

Ketamine has been showing promise for treating a variety of conditions. Earlier this year, ketamine nasal spray was shown to quickly reduce suicidal ideation in patients being treated in the emergency room.

View the original article at thefix.com

27 July 2018
Drug Shortages Affect Hospitals Across US

The national drug shortage has been severe enough for the FDA to allow Pfizer to sell products that normally would have been recalled.

Emergency departments across the United States are feeling the strain of drug shortages that are affecting physicians’ ability to treat pain and other ailments.

According to the New York Times, some hospitals, like Norwegian American Hospital in Chicago, have been “struggling for months” lacking crucial drugs like morphine, epinephrine (adrenaline) and diltiazem, a heart medication. Norwegian has not had morphine since March of this year, the Times reported.

According to a May 2018 survey of 247 emergency doctors, conducted by the American College of Emergency Physicians, 9 in 10 said they did not have access to important medicines, which they said negatively affected nearly 4 in 10 patients.

While the Times notes that while the reason behind the drug shortage is complex—including the fact that drug companies have little incentive to manufacture drugs that are difficult to make but “cheaply priced”—much of it has to do with manufacturing issues at Pfizer, which produces the majority of generic injectable drugs in the U.S.

“Most of the time, the problem is some type of quality issue related to machine or raw materials,” said Erin Fox, senior director of the University of Utah’s drug information and support services, according to CBS News. “It could be contaminated particles, bacteria, metal shavings, glass particles—all kinds of things. There’s a real quality control problem.”

Pfizer has received multiple warning letters from the Food and Drug Administration regarding issues of quality control, forcing it to slow down production while it addresses these issues. The company estimated that many of its drugs, like morphine, will not be available until 2019, according to the Times.

Incredibly, the drug shortage has been severe enough for the FDA to allow “Pfizer to sell products that normally would have been recalled: In May, Pfizer released morphine and other drugs in cracked syringes, with instructions to health care providers to filter the drugs before injecting them,” the Times reported.

Being the largest pharmaceutical company in the nation, Pfizer’s shortage issues have carried over to competitors who have struggled to fill the void.

The lack of pain medications has been a “huge issue,” according to one emergency room doctor at Norwegian American Hospital. “[Patients] are often disappointed and frustrated that the system is not functioning at the level it should be.”

Fox, who studies drug shortages, explained that the shortage of pain medications not only has to do with manufacturing issues, but opioid restrictions put in place by the government in response to the drug abuse epidemic.

View the original article at thefix.com

6 July 2018