Treating addiction in the ER: One doctor's success against the heroin epidemic
by Jane Flasch
Wednesday, August 15th 2018
Buffalo, N.Y. (WHAM) - People addicted to opioids - upwards of ten every day - crowd into the Erie County Medical Center. As an emergency room doctor, Josh Lynch is on the front lines.
"It was happening over and over again," Dr. Lynch said. We were seeing the same people either overdose or come back to the ER."
Many emergency rooms administer Narcan, stabilize the health emergency, then send patients home. Dr. Lynch calls it a missed opportunity.
"We start them on this medicine and get them feeling better within 30 minutes, then what? Where do they go?," Lynch asked.
About a year and a half ago, with a surge in heroin and opioid use, he decided to shift the thinking.
When someone with chest pains goes to the ER, there is a checklist of what doctors will do immediately. Even if someone is not admitted, there is a plan for follow-up care. What if this model were applied to those addicted to heroin? Could ERs also be a place for treatment to begin?
"The fact that we would treat [addicted people] differently is unacceptable anymore," said Dr. Lynch, noting that opioid use affects people across all of society.
The first step: Doctors at 13 hospitals in Erie County have been specially trained to prescribe Buprenorphine - a drug known as Suboxone. It stops cravings and eases withdrawal, but it is also an opioid, so physicians must receive eight hours of education before they're allowed to use it for addiction. Nurse practitioners and physician assistants require 24 hours of training.
Those who are ready for addiction intervention move on to step two. Dr. Lynch convinced treatment clinics across western New York to dedicate treatment slots every week specifically to ER patients so they don't go on a waiting list. It started out small with one treatment center. It's grown to a pool of 60 openings per week.
Patients learn their options and make a first and second choice. The scheduling of appointments is handled immediately by Mercy Flight dispatchers - even if it's 2 a.m. They're already on the job - waiting for emergencies - and available 24/7.
"Most of the patients that we're referring get into their first choice clinic within 48 hours of their ER visit," said Dr. Lynch.
During that gap, counselors who've overcome their own addictions step in. "We try to hammer down, 'What are you going to do when you leave here? Where, specifically, are you going to go?' Then provide someone to virtually hold the person's hand until they get to the appointment," said Dr. Lynch.
"An immediate assessment is done. Peer counseling is done. It's a whole different experience," said Gates Police Chief James Van Brederode.
Three times in a two week period, Van Brederode has driven addicts who needed help to Erie County when he could not find them placement in Monroe County. He said the contrast between counties is significant.
"They have incorporated within the ER this whole idea of the addiction problem. I don't see that in any of our ERs," said Van Brederode.
A spokesperson with Monroe County tells 13WHAM News the Monroe County Health Director has reached out to officials in Erie County to learn more about the program with plans to "customize" something similar here.
Dr. Lynch says for the program to work treatment centers have to make room and make a commitment to ER patients with treatment slots available every week. It's taken about a year and a half for Erie County's program to grow to 13 hospitals and 25 treatment centers.
"Everybody kind of works together and people are noticing and taking away that this is actually working," said Dr. Lynch.