Gert Walter, MD, an emergency medicine physician at Emerson, addresses the increase in patients seeking help at the hospital who are addicted to opioids, as well as the steps the hospital, the state, and our community are taking to stem the opioid epidemic.
When did you and your colleagues observe an increase in opioid-addicted patients coming to the Emergency Department (ED)?
About five years ago we started seeing more and more people who got started on pills such as Percocet or Vicodin, either because of a doctor’s prescription, or because they obtained them from friends or family. Some people then go on to use heroin because it’s cheaper.
Because we are a psychiatric and detox facility, Emerson has always seen more patients with substance abuse problems than the average community hospital. Long before concern grew about an opioid epidemic, we were already detoxing patients from opioids and alcohol. Emerson has an excellent reputation, so we treat people from all over Massachusetts and into New Hampshire.
As an ED physician, you regularly treat patients who are in pain and have a legitimate need for a prescription painkiller.
Yes. But lately, many parents say “there’s no way I want to give narcotics to my kid.” We typically give only a small prescription of narcotics to someone who is clearly in pain or in cases where someone has injured themselves, because we arrange for close follow-up in the next few days. And we tell patients that, for example, if they are given a prescription for 30 pills, they can tell the pharmacy they only want 10.
The fact is, several years ago, physicians and hospitals were informed that they were doing a poor job treating pain; we needed to be more attentive to our patients’ pain. The pendulum swung too far the other way and was compounded by the fact that, when Oxycontin came onto the market, we were told by the pharmaceutical company that it was impossible to become addicted to it. We found out that wasn’t true.
What efforts are underway to stem the opioid epidemic?
In Massachusetts, the Prescription Monitoring Program (PMP), which was established more than a year ago, has been a big help. It’s a database that shows how many prescriptions of controlled substances a patient has. It can be eye-opening to see that someone has obtained prescriptions for opioids from 20 different physicians at 18 different pharmacies. At the same time, we may see if a patient is truly sick, because the database will show that they have one physician who is managing their need for pain and anxiety medications.
When the Prescription Monitoring Program first started, 70 percent of the physicians who used it were ED physicians. It’s very useful to us, because we don’t know the patients we treat. We also have a program now where, if a patient ranks their pain as more than 5 out of 10, a member of the staff pulls up their PMP record so that the physician can see it.
Do you screen patients for signs of substance abuse?
Yes, and we refer appropriate patients to our detox unit at Emerson if we determine that stopping the opioid pills or alcohol would be dangerous to their health. Other patients qualify for outpatient treatment. The hospital’s behavioral health staff make the arrangements. We also send a copy of the patient’s ED record to their primary care physician. Some people don’t wish to be detoxed.
Is Emerson collaborating with the local community?
Yes. I serve as the medical director for the area EMTs (emergency medicine technicians). The EMTs who work for the local fire departments have been using Narcan (naloxone), the opioid antidote, for several years. We now have a Narcan training program for area police departments. Police usually are the first ones to arrive in response to a 911 call because someone has overdosed. Narcan can also be purchased at a pharmacy without a prescription for about $10-20 per dose.
We encourage people to be aware that it is only to be used for narcotic overdoses. It is lifesaving and gives people an opportunity to get off narcotics, get into a program and get their lives back on track.