We Can Make a Difference
Emergency physicians, by virtue of their daily interactions with the most vulnerable patients, are natural agents of social change. We bear witness to the daily pain and suffering of marginalized and disenfranchised populations, the gaping holes in our social system, and the gross inequities of medical care and treatment. We understand the patients’ inherent mistrust of the medical system fueled by addiction’s underserved, stigmatized place as a failure of willpower rather than a disorder of brain chemistry. And yet, by failing to incorporate evidence-based addiction training as a skill firmly within an emergency medicine physician’s scope of practice, we continue the sad tradition of inadequate access and perpetuate stigma. We convey the message that OUD as a disease is not worth our time or effort.
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ACEP Now: Vol 39 – No 10 – October 2020Addiction training should start with equipping all emergency department residents with a Drug Enforcement Administration (DEA) X-Waiver so they can prescribe buprenorphine, and this should be incorporated into the standard curriculum of emergency medicine residency training. This training can be easily incorporated into weekly didactics, and the certification never expires. Equipping our future emergency department physicians with the ability to treat the life-threatening disease of opioid use disorder is just good medicine. We must be part of the solution.
Dr. Haroz is a physician at Cooper University Healthcare in Camden, New Jersey. Dr. LaPietra is a physician at St. Joseph’s Health in Paterson, New Jersey. Dr. Holtsford is a physician at Northwestern Medicine Delnor Hospital in Geneva, Illinois. Dr. Strayer is a physician at Maimonides Medical Center in Brooklyn, New York.
References
- D’Onofrio G, O’Connor PG, Pantalon MV, et al. Emergency department–initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636-1644.
- Larochelle MR, Bernson D, Land T, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3):137-145.
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2 Responses to “Improve Opioid Use Disorder Management by Changing Resident Training”
November 1, 2020
TirEDocIt’s difficult to “change physician behavior” on this issue because a lot of us who are more seasoned have seen the repeated failure of using an opiate based medication to treat OUD. Frankly it’s a bit suspect that this is being pushed as “a new trend” just because a pharmaceutical company has come up with a new drug that is “less addictive” than the industry’s previous formulations. I and many like me remain of the mindset to minimize patient exposure to opiate medications whenever possible, and support non-opiate detox programs which don’t support promulgation of some new drug now on the market.
November 1, 2020
John HerrickI am all for this treatment, evidence based medicine, and harm reduction. Please just get rid of the waiver. Another merit badge in order to practice evidence based medicine is counter productive and further stigmatizes and limits buprenorphine’s use. I would not expect it to become standard of care until this hurdle is removed.