How Philadelphia's EDs are combating the opioid crisis

As the opioid crisis ravages the nation, emergency department physicians in Philadelphia are trying to use data and new interventions to change the way opioids are being prescribed, according to a Philadelphia Inquirer report.

Since 2012, a working group of physicians from 21 EDs across the Philadelphia region have been meeting share data and compare opioid crisis mitigation efforts. A case study conducted by researchers at Thomas Jefferson University Hospital and Penn Presbyterian Medical Center, both in Philadelphia, and published on the New England Journal of Medicine's Catalyst website, found sharing data resulted in 15 hospitals changing their opioid prescribing guidelines.

Additionally, physicians at the Philadelphia-based Perelman School of Medicine's emergency medicine department have been trying to increase prescription of suboxone, which is an opioid, the Philadelphia Inquirer reports. Suboxone can help mitigate the withdrawal pains that cause opioid-addicted patients to return to abusing drugs without causing euphoric effects.

However, it can be hard for physicians to prescribe suboxone for several reasons. One of the most important is the fact the U.S. Drug Enforcement Administration only allows physicians who have undergone extra training to prescribe suboxone. Also, hospital policy dictated physicians could only prescribe suboxone to patients who already had a prescription and just needed it to be renewed. Physicians lobbied hospital management to allow suboxone prescriptions where possible.

Another tactic being tested out in Philadelphia EDs is a new version of "warm handoffs." At Philadelphia-based Penn Presbyterian, patients are connected with treatment by peer specialists who have been through addiction and recovery, according to the report.

Temple University Hospital in Philadelphia, which was among the first in the city to create opioid prescription guidelines, tries to refer chronic pain patients to holistic pain treatment programs rather than have their busy ED physicians prescribe opioids. Temple's physicians also won't refill a patient's opioid prescriptions if they run out.


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