Why are Some People Going to Rehab in the ER?

Why are Some People Going to Rehab in the ER?


An Exciting New Way to Treat Addiction!

A team of researchers from Yale University may have just discovered the magic bullet in treating opioid addiction! Okay, that’s a bit over the top, but a recent study from Yale does highlight a new and highly effective type of addiction treatment.

opioid addiction treatment emergency room-min

Dr. Gail D’Onofrio, the Chair of Emergency Medicine at the Yale School of Medicine, and Dr. David Fiellin, a Professor of Medicine, led this study published in the Journal of the American Medical Association. They examined over 300 patients seeking emergency medical attention for addiction related reasons (things like overdoses or abscesses).

Normally, when an individual ends up in the ER for these reasons, they’re stabilized and given a referral to an addiction treatment center. Maybe they’re kept overnight, or even for a day or two, but that’s it.

Dr. D’Onofrio and Fiellin’s study, however, kept patients in the ER for an extended period of time, gave them the maintenance drug buprenorphine (also known as Suboxone or Subutex), and then followed up with time in rehab.

What was the outcome of this varied approach? Was it effective in helping individuals recover from addiction? More importantly, how does it compare to the “traditional” emergency room experience? Find out below!

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The Surprising Results

The results are in and it looks like Dr. D’Onofrio and Fiellin may have changed how opioid addiction is treated in America. Again, that’s a bold claim and perhaps a bit hyperbolic. The numbers don’t lie though and these numbers are looking good.

D’Onofrio took patients in emergency rooms for opioid related reasons and divided them into three groups. The first group received the traditional ER response – stabilization and a list of local treatment providers. The second group received a more personalized response – stabilization, a “motivational consultation,” and a referral.

In the third group, however, things got interesting. These patients received a “brief intervention,” were introduced to buprenorphine treatment, and continued this treatment in a primary care setting. They were also involved in various forms of addiction treatment (residential, partial hospitalization, and outpatient levels of care).

So, which group did best and how, for that matter, do we even measure “best?” Well, the classic test is abstinence from illicit opioid use. It’s important to remember that this doesn’t mean only using heroin or illegal opioids, but also abusing painkillers or even abusing the buprenorphine they’re prescribed.

As for which group did best, Dr. D’Onofrio had the following to say, “The patients who received ED-initiated medication and referral for ongoing treatment in primary care were twice as likely as the others to be engaged in treatment 30 days later…They were less likely to use illicit opioids of any kind” (Yale News).

Twice as likely! In a world where sobriety is measured in single digit numbers, “twice as likely” is pretty amazing. Now, it’s important to remember D’Onofrio isn’t talking only about sobriety, but rather about patients continuing to seek addiction treatment.

Still, this certainly shakes up the world of addiction medicine and treatment. Dr. Patrick O’Connor, a Professor of Medicine and Chief of General Internal Medicine at Yale, had the following to say about these developments,

“Effectively linking ED-initiated buprenorphine treatment to ongoing treatment in primary care represents an exciting new model for engaging patients who are dependent on opioids into state-of-the-art care” (News Medical).

Too Good to be True?

Dr. D’Onofrio and Fiellin’s research may well herald a new approach to treating heroin and painkiller addiction. That being said, let’s take a closer look at what exactly is going on. After all, buprenorphine treatment isn’t without its critics.

This study measured the percentage of patients who sought addiction treatment after a drug related ER visit. Of the three groups studied, the group that received buprenorphine was most likely to end up in treatment and maintain abstinence.

The two immediate questions this raises, in my mind anyway, are how important is seeking treatment and can time spent on buprenorphine be considered abstinence?

suboxone in the er-min

So, how important is seeking treatment for drug or alcohol addiction? Very important! Perhaps a better question would be – is this a valid way to measure “success?” I’m not so sure it is.

Success should be defined by how well an individual responds to whatever type of treatment they’re receiving. After all, thousands, even hundreds of thousands, of people end up in treatment each year. Are they all “successful?” In some ways certainly, but in many others they’re not.

This brings us to the second question, is someone sober if they’re on buprenorphine? Again, I’m not so sure. Yes, buprenorphine is very different from most opioids. It’s still an opioid though. Those on it are still having their opioid receptors saturated by the drug.

I think the choice about whether to take buprenorphine comes down to, ultimately, an individual, their doctor, and a God of their own understanding. That is to say, what’s right for me may not be right for others. Still, it’s usually better to try true abstinence first. If that doesn’t work, then perhaps buprenorphine will.

Regardless of the questions raised above, I think we can all join together and view this new research as positive. After all, anything that can help fight the opioid war is a good thing.

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