Last fall the U.S. Surgeon General issued its first-ever Report on Alcohol, Drugs and Health, signaling America's drug addiction epidemic should be more of an urgent healthcare priority.
Why the report matters
The last time the Surgeon General issued a report on substance abuse that was also the first of its kind, the year was 1964 and smoking was both in fashion and at its peak. The 1964 report signified a dramatic turning point, however. Since the report's publication, the number of Americans who smoke has reportedly plummeted from a record high of 42 percent of the population (in 1964) to 18 percent today.
This latest report may have similar potential for changing public awareness—in this case, regarding drug and alcohol abuse more generally. Much of the terrain covered in these pages may not be new for hospital providers, many of whom will already be familiar with the seriousness of a public health crisis that is now the leading cause of accidental death in this country.
Key contours of that terrain, as captured in an NPR interview with Surgeon General Dr. Vivek Murthy just days following the release of last year's report, include some of the following statistics:
• More Americans use prescription opioids than use tobacco.
• One in five Americans binge drink.
• There are more people with substance use disorders than people with cancer.
3 Takeaways for hospital leaders
Not surprisingly, there are some clear takeaways here for healthcare and hospital providers who find themselves caring for patients with possible substance abuse issues. While the report explicitly references a number of these, at least three stand out for their relevance to a hospital setting:
1. The need for better screening of incoming patients for substance abuse issues. Hospitals may be the first point of access to healthcare for people with substance use disorders, on the basis of the fact that "most people with substance use disorders do not seek treatment on their own" (to quote the report), but often do seek help for other medical issues. These can run the gamut from acute illness, injury or overdose—the last case being a clearer sign that a SUD may be in play—to chronic conditions like depression or diabetes. It's imperative that hospital leaders have assessment tools in place that help ER providers screen patients for substance abuse upon admission. The same assessment tools should be available to primary doctors and specialists who may see patients for routine check-ups or other presenting issues. Screening is the first step to accessing appropriate levels of care and treatment for a patient with a SUD, after all.
2. The need for patient education about drug and alcohol abuse and its medical dangers. More information from medical providers about the medical dangers of drug and alcohol abuse can only be a good thing, regardless of where a patient may fall on the continuum of substance abuse (from more mild to more severe). One reason is "mild substance use disorders may respond to brief counseling sessions in primary care." That reduces the risks of a progression to more severe stages of substance abuse further down the road. But patients with more severe addiction can also benefit from a few minutes of direct talk from a physician regarding the dangers of their condition and resources available in the form of residential or inpatient treatment services. (Here hospital leaders can also do better at referring patients to trusted substance abuse services.)
3. The need for greater coordination between primary, emergency care and substance abuse treatment providers. With greater technology integration, via electronic health records, telehealth, health information exchanges, and other tools, hospitals have an unprecedented opportunity to monitor and provide closer follow-up to patients who currently are falling through the cracks. As evidence of this trend, the Surgeon General cited a recent study that found that doctors continue to prescribe opioids for 91 percent of patients who suffered a non-fatal overdose, with 63 percent of these patients continuing to receive high doses. Just under one in five of these patients overdoses within two years, suggesting a need for more "effective coordination between emergency departments and primary care providers."
That same kind of integration and coordination needs to happen between hospitals and substance abuse treatment providers, however. In the words of the Surgeon General: "When health care is not well integrated and coordinated across systems, too many patients fall through the cracks, leading to missed opportunities for prevention or early intervention, ineffective referrals, incomplete treatment, high rates of hospital and emergency department readmissions, and individual tragedies that could have been prevented."
Edward Zawadzki, D.O. is FAPA Forensic Psychiatrist and Medical Director of Beach House Center for Recovery, a drug and alcohol addiction rehabilitation center in Juno Beach, Florida. He has won multiple awards in honor of his contributions in patient care and in neuropsychological research.
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