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Emergency Medicine and Addiction: A Critical Intervention Point

Updated: Sep 12, 2020

By Jessica Hulsey Nickel

It is easy to get lost in the dizzying data of our nation’s overdose epidemic: 63,600 drug overdose deaths in 2016, a number larger than the entire population of Terre Haute, Indiana.

We are losing the equivalent of a plane crash every day in America. If those planes were actually going down every day the FAA would stop operations until they found out exactly what was going on, yet we are still slow and struggling to take a response to scale to address the opioid crisis nationally.

The numbers don’t adequately convey the heartache and loss that accompanies the disease of addiction either. This loss includes Aimee Manzoni-Darpino from Massachusetts getting to beam with pride at her beloved son Emmett’s college graduation. Emmett would have been graduating this month, had his life not been tragically cut short following a string of seven prior non-fatal opioid overdoses. It includes Doug Griffin from New Hampshire one day walking his beautiful daughter Courtney down the aisle. Courtney passed away due to a fentanyl overdose after insurance coverage was repeatedly denied for the substance use disorder treatment she so desperately needed.

These tragedies can be prevented. We know who our most at-risk patients are: those who have already had a non-fatal overdose are at heightened risk for a fatal overdose. In fact, an estimated 70 percent of people who die of an overdose had previously experienced a non-fatal overdose. Our Emergency Departments (ED) are on the frontline of this public health emergency. Between 2005 and 2014, the national rate of opioid-related ED visits increased 99.4 percent, then increased another 29.7 percent from July 2016 to September 2017. Recognizing the critical need for ED interventions for patients suffering with substance use disorders, the Addiction Policy Forum launched its Emergency Medicine Initiative—which includes a toolkit and other resources-- to support health systems and patients.

As we move as a society from viewing addiction as a moral failing to treating it as the health condition science has proven it to be, we must address it in our healthcare system with the thoughtful urgency this epidemic requires and support our medical providers with the necessary infrastructures and protocols to do so. We are fortunate to have important tools in our toolbox: screenings, medications to treat addiction, naloxone to reverse overdoses and training resources. By layering these and other innovative interventions, we can transform a trip to the ED into an opportunity for linkage to treatment and recovery.

The toll of not supporting our nation’s health systems to address our most vulnerable patients’ needs is a price we cannot afford: we are losing 174 sons, daughters, sisters, and brothers each day to drug overdose, a generation of Americans lost to a treatable disease. By changing how we respond to non-fatal overdoses, we can have the biggest, quickest impact and save the most lives.

Jessica began working in prevention at 15 years old through an anti-drug coalition in southern California. The next chapters included an appointment by President Bill Clinton to serve on the Drug-Free Communities Commission, serving as a legislative aid in the U.S. House of Representatives, and work to pass and fund the Second Chance Act to help individuals returning home from prison and jail. In 2015, Jessica founded the Addiction Policy Forum to help families and patients struggling with the disease of addiction. Frustrated by the lack of progress in improving outcomes for those individuals and families struggling, she started the nonprofit with $13,000 from her own savings account and long hours at the dining room table. Read more about Jessica Hulsey Nickel.

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