Why Hospitals Offer Treatment Referrals In Lieu Of Addiction Services?

By Paul Gaita 09/24/18

Only 5% of ER doctors work in hospitals that offer buprenorphine or methadone.

doctor speaking with patient in hospital

A recent Huffington Post feature highlights a conundrum within the medical community's response to the opioid crisis: emergency room patients with opioid use disorder who receive a dose of buprenorphine are twice as likely to continue treatment within the next 30 days than those who were referred to outside treatment facilities.

Despite those statistics, a survey by the American College of Emergency Physicians (ACEP) found that only 5% of ER doctors work in hospitals that offer buprenorphine or methadone, of which there are less than 100 in the United States.

The ACEP study, which polled 1,261 emergency physicians in 2017, found that 9 in 10 respondents felt that the number of patients seeking opioids had increased or remained the same during that year. But at many hospitals, patients seeking medical assistance for addiction-related issues are given the phone number for local clinics.

Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University, cites a number of reasons why this approach might be favored over administering buprenorphine or other opioid treatment drugs.

Emergency doctors and nurses may have antipathy towards drug users, who are often in their worst possible states when arriving at emergency services, said Kolodny. Hospital administrators, too, may perceive such patients as poor insurance risks, especially those in states that have not expanded Medicaid; offering services beyond treatment referral could take up staff and available beds.

Prescribing buprenorphine also requires a license from the Drug Enforcement Administration (DEA), and many physicians are not willing to complete the eight hours of clinical training required to receive it.

But as the Huffington Post feature notes, a number of hospitals across the U.S., including 10 in Maryland and multiple locations in California and South Carolina, do offer addiction services, which typically entail screening by caregivers and an interview with a peer recovery coach to determine if the patient is willing to accept treatment.

ER doctors and nurses will treat the patient's most urgent medical needs, and then administer a dose of buprenorphine. 

A 2017 study by the Yale School of Medicine found that patients with opioid use disorder who receive such a dose in an ER were twice as likely to be involved in some form of treatment a month later, compared to those who were not. Dr. Eric Weintraub, an associate professor of psychiatry at the University of Maryland School of Medicine, is a proponent of addiction services in emergency rooms, and now works to help other hospitals adopt that approach.

"We've learned that certain places are conducive to engaging patients in treatment," Weintraub told HuffPost. "One of them is the ER. The other is the criminal justice system. We need to grab those opportunities and offer patients effective treatment when they're ready."

Currently, addiction treatment specialists are watching addiction services programs in Maryland and other locations to see if the approach proved effective over long-term periods. "If this movement… is successful and starts to become normalized nationwide, it could change everything," said Kolodny.

"If you really want to see overdose deaths come down in the United States, getting treatment with buprenorphine has to be easier and cheaper for people with substance use disorders than getting heroin or other opioids off the street," he said. "And what could be easier than walking into an ER and getting started on buprenorphine?"

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, Amazon.com and The Los Angeles Beat, among many other publications and websites.