A 32-year-old female with anxiety and recent bimalleolar ankle fracture presents requesting help with her addiction to opioids. She was started on a short prescription of oxycodone after undergoing a minor operation to repair her fractured ankle. She finished her prescription and continued to feel pain, so she went to her primary care physician, who felt uncomfortable writing her a prescription for additional opioids. She initially resorted to using leftover Percocet from her husband’s previous injury. Once these were gone, she started seeking pain medications from friends and family and eventually began to buy prescription opioids from a drug dealer in the town where she grew up. As the cost of her addiction rose and she was unable to support her habit with prescription opioids alone, she resorted to snorting heroin for the first time one week prior to presentation. After she sobered, she realized she had a problem. “I never signed up for this” was the refrain she gave to the triage nurse as she told her story. She called her dealer to state she wanted to sever contact between the two of them, and the dealer agreed that her habit was escalating and that she was right to consider quitting. An hour later, this same dealer came to her apartment with a “parting gift.” It was another dozen oxycodone “on the house” because she had been “such a good customer.” Her husband intervened before she used them, and together, they presented for evaluation.
The rising death toll from our nation’s opioid epidemic has been rivaled in modern medical history only by that at the peak of the AIDS epidemic in the early 1990s. Consider, in 1995 at the peak of the AIDS epidemic, 51,000 Americans died from the disease. In 2015, 52,000 died from drug overdoses.
Emergency departments have stood at the front lines of both crises. Walk into any of our nation’s emergency departments and you’ll find no indications that we are reaching a plateau in rate at which lives are lost to opioid use disorder (OUD).
You’ll also find limited utilization of solutions that work.1
In the early days of the AIDS epidemic, emergency departments often served as the entry point of care for those patients who presented with sequelae of the deadly disease. During that time, emergency physicians served as primary providers for vulnerable HIV patient populations, diagnosing critical AIDS-defining illnesses and treating patients suffering from the maladies of those conditions.