ER Doctors: Drug Overdoses Put Strain on Emergency Rooms

If the first quarter of this year is any indication, the hospital will see at least as many overdose patients in the emergency department by the end of 2017.

According to emergency department admission data, it treated 48 overdose cases between Jan. 1 and April 30. Those include opioids and synthetic drugs, and accidental and intentional overdoses.

Although most of the drug overdoses seen at Owensboro Health are intentional, "there are more accidental overdoses (than in the past)," said Dr. Charles Hobelmann, an emergency department physician at Owensboro Health.

Of the overdose cases coming into the emergency department, the majority are caused by opioids and amphetamines, Hobelmann said. The hospital tests overdose patients for amphetamines, such as meth, and other drugs.

"Amphetamines cause agitation, but opioids cause more medical problems and need for intervention," Hobelmann said.

Methamphetamine is still the dominant street drug in Daviess County, but the region has seen heroin overdose deaths, and opioid overdoses are not uncommon. Other parts of the state have been hit worse. Heroin, fentanyl and prescription painkillers such as OxyContin have plagued Lexington, Louisville and northern Kentucky, causing multiple deaths while raising concerns of increased transmission of communicable diseases like Hepatitis C through the sharing of used needles.

According to the Governor's Office of Drug Control Policy, there were 1,248 overdose deaths in Kentucky in 2015, the last year for which statistics are currently available. Of those, heroin was found in 28 percent of overdose deaths, and fentanyl or a combination of heroin and fentanyl was found in 34 percent.

Dr. Andrew Bernard, chief of trauma and acute surgery at UK Health Center in Lexington, said opioid overdoses are much more serious than other types of drug overdoses.

"We see some cardiac complications from using meth, because it's like a stress test," Bernard said. But opioids suppress the respiratory system, which causes serious medical problems with permanent effects, he said.

In the most serious opioid overdoes cases, "they've lost consciousness, stopped breathing, had a cardiac arrest or are to some extent brain damaged and are on a respirator," Bernard said. "... We don't see these life-threatening overdoses (with other drugs) like we see with opioids, because of their ability to suppress breathing."

When asked if most people seen at UK Heath Center for opioid overdoses are admitted, Bernard said: "I suspect the majority of them are discharged... They wake up and say, 'I want to go home.'" If an adult patient is determined to have decision-making ability and is not suicidal, they have the authority to check themselves out, he said.

Ambulances and responders in Louisville, Lexington and other cities (including Owensboro) carry Narcan, which can immediately counteract the effects of an overdose. Narcan wears off and the person likely needs additional treatment, but Bernard said he's heard of overdose patients who refuse to go to the hospital after being revived.

"We hear from paramedics, 'I went to the same house more than once in a single shift," Bernard said. "You can't really force a patient to go... and later in the day, they are using again."

Hobelmann said overdose cases strain the emergency department at Owensboro Health by tying up resources needed for other patients.

"The big thing about overdoses is it requires intervention and critical care, and is going to require more resources," Hobelmann said. "They have to have one-on-one care, or one-on-two care.

"The longer they stay in the ED and require higher levels of care... we get bogged down," Hobelmann said.

The underlying problem is opioid addiction, which officials in substance abuse treatment have said previously almost always starts with an addiction to prescription opioid painkillers. Hobelmann and Bernard said physicians are changing they way they treat pain.

When fears were raised that over-prescribing of antibiotics was creating antibiotic-resistant bacteria, UK established an antibiotic stewardship committee, Bernard said. The medical center now has a similar committee to curb over-prescribing of opioids.

"Addiction is the problem," Bernard said. "We now have an opioid stewardship committee, because we as an organization and profession have realized prescribing opioids is harmful to the greater good. Most patients get too much when they get (opioids), either too high a dose or (for) too long a duration."

Of the stewardship committee, Bernard said: "We've done that because we've realized we (physicians) are a major part of the problem. So many people who are heroin addicted, they didn't hit heroin first. The first thing they did was take someone's pain pill."

James Mayse, 270-691-7303, jmayse@messenger-inquirer.com, Twitter: @JamesMayse

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