The Definition of Insanity: Addiction Treatment in Emergency Departments

By MaryBeth19 11/08/17
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As I watch the nation wide overdose death rates continue to climb, I wonder what it will take before the physicians responsible for helping fuel this disease begin to act ethically treating addiction as the chronic brain disease that scientific research has proven it to be. I wonder how many deaths it will take before hospitals across our country begin to designate beds for the in-patient treatment of addiction after an overdose.

We now know that using drugs repeatedly whether they be prescribed opioids or illegal heroin changes both the function and structure of the brain. Drugs hijack the brain’s control circuits resulting in the compulsive behavior that defines addiction. The addict’s brain’s motivational pathways are rewired, resulting in continual drug use becoming the main drive for the individual suffering from this disease.

Unfortunately, the public and many who practice medicine continue to believe that drug addiction is a moral failing. A flaw of character or a failure of will. Many believe that if an addict wants to stop using its as simple as just not using ever again.

Medical research contradicts this outdated perception. The majority of the biomedical community now understands that addiction is without a doubt a brain disease manifested by the persistent changes in both brain structure and function caused by the destruction of long term opioid use.

The National Institute on Drug Abuse presented a detailed discussion regarding how addiction must be treated. “As with other brain diseases such as schizophrenia and depression, the data show that the best drug addiction treatment approaches attend to the entire individual, combining the use of medications, behavioral therapies, and attention to necessary social services and rehabilitation. These include family therapy, mental health services, education and vocational training, and housing services”.

What society and the Medical Community seems to forget is that approximately 80% of those addicted became so after being over prescribed opioids for acute post op pain or for a simple back ache. Even after the addictive properties of opioids became know, physicians continued to over prescribe. Addiction is a physician created disease. Physicians must take the lead in treating the disease they created with the body of knowledge scientific research has provided and ensure that patients are provided the quality and quantity of treatment required to improve patient outcomes.

When comparing Delaware to the rest of the nation, The Center for Disease Control ranked my state number 1 in the rate at which high dose opioids are prescribed. Number 1 meaning that Delaware physicians had a significant impact on fueling this epidemic in my state. My question remains with all the scientific research available to the medical community, why has nothing changed in how we treat this brain disease?

The definition of insanity is continuing to do the exact same thing over and over but expecting a different result. Unfortunately, this is how we continue to treat addiction in Delaware. I call it the revolving door of treatment. A few days here, a few days there. We lack continuity of care. Providers continue to think that 5 to 10 days in a detox followed by out patient care will keep addicts clean. Insane.

Our state Insurance continues to limit both the number of in-patient and out-patient days per year, while our medical center refuses to provide long term, comprehensive treatment in the hospital setting that could result in the decline of overdose deaths. It has been proven that by increasing any patient’s time in treatment your outcomes will improve. Why should the disease of addiction be any different?

Christiana Care Health Systems located in my state of Delaware is one of the country’s largest health care systems. Ranked 21st in the nation and 10th on the East Coast for admissions. What Christiana Care neglects to have is a specific unit for those who suffer from the brain disease of addiction. We have units for cardiac patients, trauma patients, even bariatric surgery patients, but for the disease that is killing more people than both gun violence and motor vehicle accidents we have no addiction unit. Out of Christiana’s total of 1,100 beds not one is designated for treating an overdose victim after revival with Naloxone. Not one bed in a major medical center who’s state is ranked number 1 in the prescribing of high dose opioids. Insanity.

During my career as a NICU nurse employed by Christiana Care, I witnessed the population of infants born with Neonatal Abstinence continue to increase. The administration recognized the need to open a unit specific for the care and treatment of these special infants. At the same time the parents of these infants continued to face multiple roadblocks when attempting to find help for their addiction. How many infants must lose their parents before these same administrators choose to provide the same level of care as they did for these addicted infants?

Many patients reported being discharged to the streets alone after being revived by Naloxone. During my sons addiction I knew of patients being discharged from the Emergency Department alone with no warm hand off or information on where to turn next for treatment. My son was told his vitals were stable and handed discharge papers. I was lucky my son made that phone call to me.

Sadly, this practice continues today. Parents have reported never being notified that their child suffered an overdose. The emergency department blames HIPAA. Stating the addicts are adults and are responsible for their care. I wonder why families are notified after an MVA involving a loved one but not after an overdose?

To my knowledge, no other disease is treated as shabbily as addiction. As a Registered Nurse, this practice of discharging patients literally brought back from death without supervision or a plan of follow up treatment continues to enrage me. How many more young Americans must die before the administrators of major medical centers recognize the insanity of addiction treatment in their emergency departments? When will they determine that those revived by Naloxone require in-patient stabilization? When will parents be given the peace of mind knowing that their adult son or daughter will be transferred to a unit bed in a monitored safe environment rather than back to the streets?

Policies and protocols must be set in place ensuring those who survive an overdose are treated with the same compassion and level of care as someone who survived a cardiac event. The discrimination against the disease of addiction must stop. Physicians and nurses working in every Emergency Departments must be educated about addiction as they are about every other chronic treatable disease. Stigma must be replaced with compassion.

Addiction must be recognized as a chronic, treatable brain disease, not a moral failing.

The expectation of different outcomes while addiction treatment after overdosing in emergency departments continue to be substandard is complete insanity. It is in everyone’s best interest to approach addiction as a treatable disease ensuring that those suffering from substance use disorder receive scientific based long term treatment, otherwise mother’s like me will continue to bury our children.

https://health.usnews.com/wellness/health-buzz/articles/2017-05-15/the-1...

http://sussexpost.com/viewpoints/delawares-opioid-addiction-epidemic-top...

http://www.nejm.org/doi/full/10.1056/NEJMra1508490

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