I had a special reason for engaging with this subject when I saw a journal article last week. I know that despite what many may believe, hospitalizations for overdose or other addiction related issues rarely lead the hospitalized person to further inpatient care. We rarely see overdose victims entering even outpatient treatment programs after discharge from a hospital. I wanted to investigate the reasons for this fact. The people that I write for, the talented professionals at the best drug and alcohol rehab in Florida, Florida Springs Wellness and Recovery Center, have a background in treating overdose patients. We also have programs in place for reaching patients after a hospitalization, but I wanted to discuss this problem because despite those positive efforts, the larger problem persists nationally.
The research I used for this article comes from the Department of Medicine at the Oregon Health and Science University. They state that although hospitalizations are rising along with the overall rates of overdose and death from addiction, “Most hospitals lack systems to treat SUD, and most people with SUD do not engage in treatment after discharge.” SUD is substance use disorder, which is the medical terminology for both drug and alcohol addictions and disorders.
Addicts in Emergency Rooms
I challenge any reader who gets an opportunity to ask an emergency room nurse or physician about patients in withdrawal, and I would bet that you meet with some level of frustration. Anyone familiar with drug addiction and its treatment will know that people with substance use disorder land in emergency rooms all the time. People with opioid use disorders end up in emergency rooms because of overdoses, but also because of severe withdrawal and the associated dehydration and discomfort that goes along with it. Emergency rooms have methods of treating overdoses, of course, but they are generally not equipped to help patients in withdrawal from drugs. People in withdrawal from alcohol are given benzodiazepines I assume, as failure to treat alcohol withdrawal correctly can lead to seizure or death, but opioid addicts are often left to suffer as emergency rooms refuse to give people with substance use disorder methadone, which is the obvious antidote to severe withdrawal from opioid drugs. Even if that situation is not ideal, it seems to be a better answer than kicking people back to the street where they cannot receive other much-needed health and social services and are at even greater risk of overdose as they have not had their drug of choice for a prolonged period. This is not purely a choice made at the emergency room or hospital level. Hospitals and doctors’ hands are collectively tied behind their backs when treating addicts, because giving methadone for any reason other than pain has been taboo in the United States for more than two decades. The best-known use for methadone is generally off limits to most doctors because of wrongheaded laws and protocols around methadone in particular.
Addicts After Discharge
The researchers wanted to find out “the effect of a hospital-based addiction medicine consult service, the Improving Addiction Care Team (IMPACT), on post-hospital SUD treatment engagement.” This is particularly important to me as it mirrors programs I have seen discussed, and as I explain above, we are not in a comfortable position with current hospital-based addiction care.
The program they looked at, IMPACT, “included hospital-based consultation care from an interdisciplinary team of addiction medicine physicians, social workers, and peers with lived experience in recovery. IMPACT met patients during hospitalization; offered pharmacotherapy, behavioral treatments, and harm reduction services; and supported linkages to SUD treatment after discharge.” They report that less than 20% of people hospitalized for substance use disorder problems were previously enrolled in a program of care for SUD. Those people who were approached in the hospital setting by the IMPACT team were more likely to seek treatment from a qualified facility upon discharge from the hospital. The reason that I believe this is necessary should be evident. The current protocols for hospital care are lacking, and without a change in the current protocols patients with substance use disorder are much better off in a dedicated program of recovery outside of the hospital. The best drug and alcohol rehab in Florida is Florida Springs in Panama City, and we have been interested in similar programs and working with hospital personnel on implementation of similar services to those seen in this Oregon study.
By T.A. Cannon (Contact me at TACannonWriting@gmail.com)
ENGLANDER, H. et al. Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis. Journal of general internal medicine, [s. l.], v. 34, n. 12, p. 2796–2803, 2019. DOI 10.1007/s11606-019-05251-9. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=31410816&authtype=geo&geocustid=s8475741&site=ehost-live&scope=site. Acesso em: 12 abr. 2021.