Policymakers and health professionals must collaborate to fight addiction
© Getty Images

 

Emergency physicians see first-hand the toll of opioid abuse and misuse — on people, families and communities.

We have a close-up and personal view of this national disaster, because every day we treat patients who have overdosed, and we have witnessed their tragic deaths.

We see more patients in acute pain than in almost any other medical setting. It is the most common reason patients seek emergency care.

ADVERTISEMENT
The challenge is that most emergency patients legitimately need treatment for pain, but there is no objective test to verify whether a person is in pain. At the same time, patients are asking, often demanding relief for pain from physicians who likely have never seen them before. All patients must be treated on a case-by-case basis, with compassion, safety and quality in mind.

 

In emergency medicine, we rarely prescribe extended release opioids or prescriptions for more than a few days. That’s why a recent New England Journal of Medicine study found that “prescriptions provided by other physicians in the months after an emergency department visit are necessary for long-term opioid use to take hold.”

Furthermore, the American College of Emergency Physicians (ACEP) has been educating emergency physicians for years about safe prescribing guidelines, and these efforts have shown success. According to a 2015 American Journal of Preventative Medicine study, the largest percentage drop in opioid-prescribing rates has occurred in emergency medicine.

Well-intentioned policymakers and politicians have proposed mandatory limits on how much medicine physicians can prescribe or how much medicine a person can receive, without regard to the patient’s medical history or access to other parts of the health care system. We now have databases that physicians can — or in some cases, must — review to learn if a patient has a history of drug-seeking behavior. Some states have already implemented prescribing guidelines, and yet the problem persists.

Emergency physicians support evidence-based, coordinated pain treatment guidelines that promote adequate pain control, health care access and flexibility for physician clinical judgement.

Medical specialty societies should be the primary sponsors of these guidelines. To that end, ACEP has actively engaged in developing pain treatment guidelines with the American Medical Association, Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) and the Office of National Drug Control Policy.

Emergency physicians support effective, interoperable and voluntary state prescription drug monitoring programs (PDMPs) that push prescription data to emergency department providers, rather than requiring them to separately sign into and pull the data from the PDMP.

We also see the value and importance of drug treatment programs and the need for more of them.

“Warm Handoff” pilot programs in certain states — for example — help overdose survivors go from the emergency department directly into a drug treatment program.

Emergency physicians also support the prescribing of naloxone to at-risk patients (per SAMHSA recommendations), naloxone availability for first responders, and education of overdose recognition and safe naloxone administration by non-medical providers.

This should be paired with legislation that would make health care providers and lay users of naloxone immune from liability for failure or misuse of bystander naloxone.

Finally, emergency physicians are leading the way at state and local levels to decrease opioid prescribing.

This includes innovative and successful programs, such as the state Emergency Department Information Exchange (EDIE) in Washington, Oregon and California, Utah, Montana, Arkansas, New Mexico, West Virginia, Massachusetts and New Hampshire, as well as efforts to use alternative, non-opioid pain management protocols supplemented with patient support networks. Alternatives to opioid pain management must be easily accessible to patients, including adequate coverage by insurance companies.

We are committed to working with our medical colleagues, the public and policymakers to enact meaningful reforms to end this epidemic that has destroyed so many lives.

Rebecca Parker, MD, FACEP, is the president of the American College of Emergency Physicians and a practicing emergency physician in Park Ridge, Illinois.


The views of contributors are their own and are not the views of The Hill.