When William needed help, he was repeatedly turned away by hospitals

After reviving a patient who has overdosed, hospital emergency departments often miss an opportunity to engage the patient in substance use disorder treatment.

By Margot Head

On the list of systems that failed us are emergency rooms and hospitals. Their approach to addicts was by and large ill-informed, judgmental and impatient. Catch and release, stabilize and send them on their way, a revolving door. To wit, our son had at least fifteen overdoses in 2012 and nineteen emergency transports to hospitals.

In these ERs, we as parents had to beg for psychiatric consults. If we got one it was always, “well, he’s not psychotic, doesn’t meet the criteria so get out of here.” What if only any one of four different hospital emergency rooms recognized that William’s repeated overdoses made him a danger to himself and entertained the notion of assessing him for a dual diagnosis?

In records I obtained, an ER attending doctor wrote that he believed William was at risk for overdosing on heroin but because he did not meet criteria for involuntary psychiatric hospitalization – the standard the hospital applied time and time again – he was discharged. This doctor called it correctly but sent him out anyway. All they do is give you a piece of paper with names of treatment places and shelters. This institutional indifference cost our son his life.

“I have spent a huge amount of time blaming myself, or my husband and me together, for failing our son. Knowledgeable people remind me repeatedly that it is the system that failed us and more so failed William.”

The Problem

An overdose presents a critical opportunity to engage a patient in treatment. But, because of the long-standing separation of addiction treatment from the mainstream health care system and lack of addiction training among health care providers, hospitals often just release the patient with a list of phone numbers for treatment programs, putting the burden on the patient to engage in care.

A patient who has just had an overdose and is in the throes of withdrawal is unlikely to seek treatment on their own. This is a missed opportunity to engage a patient in treatment at a critical moment.

The Solution

Hospitals should initiate care immediately in the emergency department. Hospitals have found a number of different ways to provide care, including: initiating buprenorphine for opioid use disorder in the emergency department; locating an addiction treatment program next to the emergency department so patients can be immediately transferred; and providing warm hand-offs to peers working in the emergency department.

Take Action

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Demand support for addiction care in hospital emergency departments

The Comprehensive Addiction and Recovery Act (CARA) 3.0 includes a comprehensive range of funding and policy provisions to expand and improve addiction prevention, treatment, and recovery services.