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By Rachel Bluth
The last time the heroine landed Marissa Angerer in an emergency room – naked and unconscious – in Midland, Texas, was in May 2016. But that was not her first interaction with the health system in what is about drugs. The doctors had already treated him several times, either for alcoholic intoxication, or for evils related to an excessive consumption of drugs. Although her immediate acute health issues are resolved at each episode, doctors and nurses have never addressed her underlying illness: addiction.
Angerer, now 36 years old and recovering, was battling addiction problems since she had started drinking alcohol at the age of 16. After she broke her ankle, she started taking prescription pain medications and then street opiates such as heroin and fentanyl.
Just two months before the overdose of 2016, doctors replaced an infected heart valve, a byproduct of its drug use. She left the hospital and started using the next day, which resulted in a reinfection that eventually cost her 10 toes and 8 fingers.
"[The hospital] had no program or anything to do, "said Angerer. "It's nobody's fault, if not mine, but it would have been useful if I had not been swept away."
This scenario is taking place in the country's emergency services, where the next step – a way to redirect addicted patients to treatment – remains elusive, creating a missed opportunity for the health system.
A recent study on Medicaid claims in West Virginia, which has an opioid overdose rate more than three times higher than the national average and the highest drug overdose death rate in the country, has documented this shift.
The researchers badyzed compensation claims from 301 people who had a nonfatal overdose in 2014 and 2015. By examining the hospital codes related to opioid intoxication, they followed the patient's treatment, in checking they had been billed in the following months for mental health visits, opioid consultations or prescriptions. psychiatric drugs and addiction.
They found that less than 10% of people in the study received medications such as naltrexone or buprenorphine each month to treat their substance use disorder. (Methadone is another option for treating addiction, but it is not covered by West Virginia Medicaid and was not included in the study.) During the month of the overdose, about 15% of people benefited psychological counseling. However, on average, the year after the overdose, this number fell to less than 10% per month.
"We were expecting more … especially given the national news on opioid abuse," said Neel Koyawala, a second-year medical student at Johns Hopkins Medical School in Baltimore. , and lead author of the study, published last month in the Journal. general internal medicine.
Andrew Kolodny, Co-Director of Opioid Policy Research at the Heller School for Social Policy and Management at Brandeis University, near Boston, believes this is an opportunity.
"There is ample evidence that we are not taking advantage of these easy results with individuals who have had a non-fatal overdose," Kolodny said. "We should focus our resources on this population. We should do everything in our power to get them to treatment. "
He likened this to someone who entered the emergency room with a heart attack. It is taken for granted that the patient would leave with heart medications and a referral to a cardiologist. Likewise, he wants patients who have an overdose to start taking buprenorphine at the hospital and leave with a reference to other forms of treatment.
Kolodny and Koyawala both pointed out that the lack of training and understanding of health professionals continued to undermine what happened after stabilization of the overdose.
"Our emergency room colleagues are not particularly well trained to help people in this situation," said Dr. Margaret Jarvis, medical director of a drug treatment center in Toronto. residence in Pennsylvania.
According to Angerer, it was clear that his doctors were not equipped to deal with his addiction. For example, they did not know what she was talking about when she said she was "sick of drugs," feeling sick as she pulled out.
"They were completely unaware of all this, and it completely upset my mind," she said.
When she left the hospital after being amputated from the toe and fingers, Angerer recalls that her next stop appeared to be a tent city somewhere in Midland, where she feared she would be dead. Instead, she persuaded her mother to drive her about 300 km to a treatment center in Dallas. She found him alone.
"Often, I could have gone a better way and fell in the cracks," said Angerer.
Jarvis said that if a patient presented to the emergency room with an overdose, he felt sick, uncomfortable and "miserable". But surviving this episode, she stressed, does not necessarily change their perilous situation.
"The risk of overdose is just as high the next day as the day before an overdose," said Dr. Matt Christiansen, badistant professor in the Department of Family and Community Health at Marshall University, at Joan C Medical School. Edwards from West Virginia. .
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