How Drug Abuse Affects ERs, and What Emergency Physicians Are Doing About It

SEATTLE, Oct. 10, 2013 /PRNewswire-USNewswire/ -- Opiate overdoses, doctor-shopping by patients seeking controlled substances and opiate misuse are routine enough features of emergency department patient populations that emergency physicians have developed innovative solutions to address these medical and social problems, which are detailed in studies being presented next week in Seattle at the annual meeting of the American College of Emergency Physicians (ACEP13-Scientific Assembly).

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For every fatal opiate overdose visit to U.S. emergency departments, there are 63 non-fatal opiate overdoses. Opiate overdose resulted in 106,813 ER visits in 2009, with the majority of them (67 percent) caused by prescription opiates ("Clinical and Demographic Characteristics Associated with Opioid Overdose Visits to United States Emergency Departments," M.A. Yokell, Stanford University School of Medicine, Stanford, Calif.).

"Fatal overdoses from opiates grab lots of headlines, but an equally important story is the huge volume of ER visits for opiate ODs that are not fatal," said Michael Yokell, a third year medical student at Stanford University in Palo Alto Calif. "Since treatment in ERs is highly effective at reducing the risk of death from overdose, more efforts should be made to ensure that all patients who need treatment for OD have safe and ready access to ERs for lifesaving emergency care."

"Doctor-shopping" patients, who had narcotic prescriptions from 10 or more providers in one year, were more likely to report an allergy to non-narcotic pain relievers, to request a narcotic by name, to have multiple visits for the same complaint and to have pain out of proportion to the physical exam. They were more likely to be white than non-white and come to the ER on weekends. The average number of medical providers these doctor-shoppers had seen in the previous year was 17, versus 1.6 for non-drug-seekers ("Characteristics of 'Doctor-Shopping' Patients in the Emergency Department," S.G. Weiner, Tufts Medical Center, Boston, Mass.).

"Knowing the typical characteristics associated with doctor-shoppers will give emergency physicians a better chance to identify patients with high risk for abuse when they come to the ER with pain complaints, " said lead study author Scott Weiner, MD, MPH, FACEP.

Emergency physicians are taking the lead in treating repeat emergency patients who visit the ER in search of narcotics.

For example, in San Diego, Calif., patients who made more than two emergency visits for alcohol, substance abuse or psychiatric problems were identified and flagged by the electronic medical record and consequently placed in non-medical detox programs, which reduced repeat emergency visits by 90 percent (from 137 total visits or 5.27 visits/week to 10 total visits or 1.67 visits/week over a 6-month period) ("An Innovative Solution to Reduce ED Recidivism Among Substance Abuse and Psychiatric Patients," A. Joshua, University of California San Diego, Calif.).

"Non-medical detox in community-based social programs outside the hospital may be a prudent and cost-effective way to reduce repeat ER visits for patients who are substance abusers," said lead study author Alfred Joshua, MD, MBA.

When emergency physicians and care managers in cooperation with primary care physicians set up individualized care plans for patients who were flagged as drug-seekers, the mean number of ER visits declined from an average of 7.6 per year to 2.3 per year ("Care Plans Can Reduce Emergency Department Visits for Those with Drug-Seeking Behavior," A. Flannery of Morristown Medical Center, Morristown, N.J.).

"These interventions had a meaningful impact on the behavior of our drug-seeking patients, which was beneficial to both the patients and overstressed emergency departments," said lead study author Ashley Flannery, DO.

In addition to the research being presented at ACEP13-Scientific Assembly, Jeremy Brown, MD, will offer a special one-day session on October 13th at the Washington State Convention Center called "Effective Approaches to Addressing Patients with Substance Use Disorders in the Emergency Department: A Knowledge Exchange."  Dr. Brown, an emergency physician and ACEP member, is the director of the newly formed National Institutes of Health Office of Emergency Care Research.

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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SOURCE American College of Emergency Physicians (ACEP)



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