The idea to discuss emergency rooms, and the importance of emergency departments in the opioid and addiction crisis, is based on the work of Dr. Raymond Pomm and my own observations working in this area. Dr. Pomm is the medical director at Florida Springs Wellness and Recovery Center, and he is Board Certified in Psychiatry, Addiction Psychiatry and Addiction Medicine. In 2019 he discussed the role that emergency rooms and departments play in the addiction and opioid crisis in a Webinar titled “The ED is Ground Zero for this Epidemic.” Today we will talk about why that was true at the time, why it is likely to be true in the near future, and we will discuss programs that Dr. Pomm has been involved in to address this issue of emergency rooms being central to the substance use disorder epidemic. If you or a loved one has found this site and need help finding addiction treatment, the best drug and alcohol rehab in Florida is Florida Springs in Panama City, and our wonderful staff is available at the phone number on the top of this page.
Emergency rooms and the broader system of every large hospital having an emergency department is a key reason that patients who call 911 during a life-threatening health emergency are often able to survive and recover. It may not be intuitive to people who are not exposed to addiction that emergency rooms play a key role in the opioid crisis, as an example of one large portion of the wider addiction epidemic in America. Because of pivotal policy mistakes and ongoing misunderstandings about addiction, many more people with alcohol and drug addictions will end up in an emergency room than a facility that is equipped and willing to treat addiction diseases in any given year. Before moving on, it is important that I give some key examples of policy mistakes and misunderstandings that affect addiction medicine in this country.
Bad Policy Around Addiction
Instead of discussing broader policy problems around addiction, I will now give a few examples of health care practice and policies that cause addicts to end up in emergency rooms. Family physicians not being empowered to effectively treat addiction is one major issue. The average family physician cannot prescribe buprenorphine (Subutex, Suboxone) or Methadone. Methadone and Buprenorphine are likely the two most valuable drug therapies for helping opioid addicts stop abusing their drugs of choice. That means stopping the use of heroin, fentanyl, hydrocodone, oxycontin, Percocet, and countless other street drugs and prescription drugs that are used by people with opioid use disorder. Family physicians can prescribe methadone for pain in most places, but in the United States they cannot prescribe methadone for opioid use disorder, meaning more pressure on an already overburdened methadone clinic system that has a host of its own problems.
If we discuss the fact that family physicians have not been empowered to treat addiction, we should also take this opportunity to discuss the reasons that involving family physicians in addiction treatment may be harder now than ever. Some family physicians, or general practitioners (M.D.s) preyed upon the public trust they are afforded by their position, and got their own patients hooked on various powerful and addictive drugs. Some physicians did not regard addiction, specifically opioid and benzodiazepine addiction, with the proper amount of concern and precaution. Other physicians, likely a very small number, became rich by taking cash payments to write any prescriptions that patients wanted. Although the percentage of doctors who engaged in nefarious behavior was likely tiny (probably under 1%), we now know the sheer numbers of opioids, benzodiazepines, and other drugs that they supplied to their patients devastated communities both large and small, certainly killed thousands, and helped to hook hundreds of thousands of people to drugs that are extremely difficult to detoxify people from for the sake of long-term sobriety. That is what we do at the best drug and alcohol rehabs in Florida, and I can tell you that Florida Springs in Panama City treats people every day who got their first doses of drugs from their own doctors, or at the very least from a friend or family member who did. Therefore, patients end up in emergency rooms because good doctors, who we can trust, are sometimes not allowed to use the best medications available to treat their own patients.
Honesty Around Addiction
Another massive reason that patients are mishandled when they reach emergency rooms because of addiction is the inability or discomfort that comes from being honest and open about substance abuse disorder (addiction). Two problems immediately enter the equation when a person with Substance Use Disorder goes to the emergency rooms in this country, amongst a host of other issues. Firstly, many patients have grown up with stigmatization and moralization of addiction in general, so they do not tell the doctors and nurses why they are honestly there, and they end up getting treated for stomach aches, pain, or other side effects of substance abuse. Secondly, and this is the area that Dr. Pomm’s work has shown real success that could be copied all over the country (He started a pilot program in Jacksonville called Project Save Lives), patients who seek treatment in emergency departments for addiction, including patients who are saved from deadly overdoses of fentanyl, alcohol, or other drugs, are often not referred for further treatment. Many of them are not admitted, because many of them are not insured, and being uninsured hurts your chances of being admitted to a hospital for more than a 12 hour stay. If every single opiate overdose patient was referred to basic outpatient counseling as a starting point, we could save many lives with just that minor adjustment to the way we are doing things now. Emergency room visits are so costly, the health system would most likely save money by implementing policies like this, because a percentage of emergency room visits by addicts and alcoholics (people with substance use disorder) would go away as the patient sought more appropriate care for their disease.
If you are a person with substance use disorder, especially opioid, methamphetamine, benzodiazepine (Xanax) or alcohol dependency, you have probably been to the emergency room under circumstances similar to what I am describing. If you or a loved one would like consultation about drug and alcohol treatment and rehab in Florida, call the number on the top of this page.
By T.A. Cannon (Contact me at TACannonWriting@gmail.com)
“Webinar: The ED is Ground Zero for this Epidemic: Face-to-Face with this Crisis and Winning” by Dr. Raymond Pomm