The Opioid Epidemic: New Approaches Enter the ER

Every twenty-nine minutes, a person in the US dies from prescription opioid poisoning.

The staff at University of Kentucky’s Albert B. Chandler Hospital—and several others across the country—are taking a closer look into their standard procedures as a result of this growing epidemic.

A recent STAT report reveals the struggle of US emergency departments in the battle against prescription opioid abuse. An incident wherein a patient with no history of prescription drug abuse continued to return to the ER to obtain more of the pain pills he was prescribed after a car accident became a motivating factor for the UK Hospital to issue new guidelines surround the prescription of opioids.

In the UK Hospital, opioids are now treated as a “last-resort” method of treatment in the emergency department. Other health systems have taken note.

The National Center for Biotechnology Information (NCBI) reports that over 25 million Americans suffer with chronic pain on a daily basis. Whether the result of a sustained injury, a medical condition, illness, or otherwise, persistent pain exists in households across the map.

With this statistic in mind, the prescription frequency of opioid pain medications comes into play. A survey from the National Safety Council found that 99% of primary care physicians prescribe opioids for longer than the 3-day recommended protocol issued by the Centers for Disease Control and Prevention.

In a similar study, the National Hospital Ambulatory Medical Care Survey (NHAMCS) found that emergency department visits in which an opioid was prescribed increased by ten percent between 2001 and 2010.

At UK, the new policies resulted in a near-halving of opioid prescriptions to patients who had never previously abused opioid medications. According to the guidelines, personnel would first offer alternative pain relievers such as Tylenol or Advil before considering or ultimately administering opioid medications.

The statistics surrounding chronic opioid users did not make decrease as drastically. To combat this, ER physicians and other medical personnel are being trained to “think long-term,” prescribing fewer opioids overall and guiding addicted patients toward addiction treatment.

In his interview with STAT, UK Health System’s chief medical officer Dr. Phillip Chang stated that, “Every one of us needs to feel like we’re responsible,” he said. “The feeling of, ‘I’m not an addiction specialist; that’s not my problem’ has to go away.”

While these new hospital policies are in their earliest days, it is important to note that critical thinking surrounding the opioid addiction crisis is taking place amongst the medical community.

As chronic pain continues to afflict millions nationwide, sales of prescription opioids have quadrupled from 1999 to 2014. Experts have long-noted that there is no easy solution to the opioid epidemic, as the medications will continue to exist for the necessary treatment of many afflictions.

Dr. Thomas McClellan, CEO of the Treatment Research Institute, noted in an NBC Philadelphia interview that, “About 70 percent of all the overdose deaths occur within 48 hours after the first prescription or after the first refill,” stressing that education surrounding opioid abuse is critical for today’s physicians.

“Prescription opioids are effective as pain medications. […] The problem is they also have an abuse liability,” said McClellan.