ERs adapt to treating opioid-addicted patients

As the opioid epidemic continues, more hospitals are creating programs that seek to train emergency room doctors on ways to avoid prescribing powerful painkillers.

At the University of Kentucky Albert B. Chandler Hospital, officials created guidelines to rein in prescriptions for opioids in the ER after a patient became addicted after suffering significant injuries in a car accident, according to an article from STAT. The situation left emergency physicians wondering if the man’s addiction was their fault, Phillip Chang, M.D., chief medical officer for UK HealthCare, told the publication.

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Chang said he worked to get doctors and nurses to first offer nonopioid pain relievers like Advil or Tylenol, and from there try multiple approaches before offering the opioids as a final option. Since 2014, the trauma unit has reduced opioid prescriptions to patients who had no history of opioid abuse by 50%, according to the article.

However, patients that are addicted are still getting their hands on the drugs, so Chang said hospital officials have worked to encourage physicians to cut down prescriptions to those patients as well and, when possible, push them into needed recovery treatment.

“Everyone of us needs to feel like we’re responsible,” Chang told STAT. 

Emergency department patients are looking for effective pain treatments and many assume that strong painkillers are a quick fix, so reducing prescriptions in the ER may lead to a drop in satisfaction scores. Research has found that primary care physicians, and not emergency physicians, may be a primary source for opioid prescriptions, and the Centers for Disease Control and Prevention is urging all doctors to use caution when prescribing such drugs.

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Hospital programs also seek to establish the best ways to care for these addicted patients, both in the ER and outside of it, according to an article from New Hampshire Public Radio. At Catholic Medical Center (CMC) in Manchester, New Hampshire, more than 1,000 patients that struggled with opioid addiction were treated in its emergency department. Their care needs stretch across the hospital as many are admitted to intensive care, and it even reaches the nursery, where babies born addicted are treated.

The Special Care Nursery is a place where CMC has seen significant success, William Edwards, M.D., a neonatologist at the hospital, told NHPR. Some babies are treated with morphine to ease their addiction, but most are treated with a “cuddling protocol,” which is skin-to-skin touching and feedings with their mothers in quiet, secluded rooms.