How many saves do we really make? We count the dramatic ones, like that rare thoracotomy that worked out. But we often forget to count less flashy saves that play out long after an ED visit, say, that patient who quit smoking because we took a few minutes to chat about it. We tend to overestimate how much of our careers are about the former and underestimate how much are about the latter.
Explore This IssueACEP Now: Vol 38 – No 10 – October 2019
Today, few actions that emergency physicians can take have a higher mortality benefit than obtaining an X waiver. The X waiver permits physicians to prescribe Suboxone (buprenorphine/naloxone) for opioid use disorder patients. The training takes about a day, is inexpensive, and saves lives.
Consider the impact. Of emergency patients who receive naloxone for an opioid overdose, a staggering 5 percent will be dead within one year.1 Can you think of an acute disease that we routinely discharge that has such a high one-year mortality rate? Studies suggest that maintenance therapies (like Suboxone) can save many of those lives.2 Opioid use disorder stands alone as the only major substance abuse disorder in which abstinence is more dangerous than agonist treatment with agents like buprenorphine and methadone. Opioid agonist therapy is the gold standard for opioid use disorder treatment. It reduces relapses—and reduces mortality. If we went into business to saves lives but are not willing to do this, we’re failing. If we don’t think that these patients deserve our time or efforts, we are letting our biases and blind spots get in the way. More than 70,000 Americans died from opioid misuse in 2018. This cannot stand.
Sadly, for many of our patients, a near-death experience from opioid use is not a one-time occurrence. As soon as they’re revived, they’re ready to go. You’ve probably seen this kind of patient many times. They’re glad you revived them, they are sometimes—but not always—outwardly grateful, and they’re not interested in treatment. Some take us up on our offer to take a free Narcan kit to go. But others are actually ready to quit. How can we find these patients? It’s easy. Just ask them. For these individuals, prescribing Suboxone in the emergency department is the single best way we can help them.
If I want to save the most lives during my career, mastering my cricothyrotomy and thoracotomy skills is a huge waste of time compared with being waivered and having “the talk” with opioid use disorder patients.