However, it wasn’t until the widespread utilization of medication-assisted therapies in the form of antiretroviral drug therapies that the crisis began to subside. Aided by the Ryan White CARE Act, which provided funding for these drug therapies for patients and resources for intensive physician education on the initiation of those therapies, the public health community orchestrated a multilateral response.2
Explore This IssueACEP Now: Vol 36 – No 12 – December 2017
Physicians nationwide adapted their practices to include initiation of antiviral therapies. Within two years of the introduction of antiretroviral drug therapy, the annual number of lives lost to the AIDS epidemic had been halved.3
Again, we find our specialty at the forefront of another national epidemic. That’s because many patients with OUD utilize our emergency departments as an entry point into the treatment system. In 2011 alone, there were 5.1 million drug-related ED visits.4
The AIDS crisis was difficult for emergency providers because making definitive diagnoses in the emergency department was often impossible. Further, with rapidly evolving resistance patterns, it was often impossible to start appropriate treatment in the emergency department.
“I did my training in Brooklyn through the late ’80s, and what I remember most was how sick these HIV patients were. They were coming in with diseases that we’d only read about in medical school—tuberculosis, pneumocystis, pancytopenias. Of course, we felt powerless because we didn’t have any idea what was going on—couldn’t even test for it in our department. And even after we theoretically could, we didn’t because we didn’t have ready access to medications we could start them on. It could be very demoralizing.”—Massachusetts General Hospital emergency department attending
As the death toll rises year after year in the OUD epidemic, we are fortunate to have solutions to both these issues for the current crisis. In the emergency department, we can make a definitive diagnosis of OUD, and we can begin treatment that has been shown to be effective.
Despite this opportunity, research shows that nearly 80 percent of people with OUD don’t receive any treatment, and those who present to our emergency departments for treatment often get referred to short-term detoxification or abstinence-based “rehab,” both of which have extremely poor outcomes, with more than 80 percent of patients returning to opioid use.5
A Different Course
Similar to the AIDS epidemic, advancements in medical therapies may play a role in changing the tide in this current crisis. And emergency departments, where many of these patients present, may be an optimal place to initiate this therapy.