Facing an overdose epidemic, some EDs offer addiction treatment

ED doctors combat opioid overdoses with on-the-spot treatment

Emergency department physicians often automatically refer patients with substance use disorder to local treatment clinics, but that standard is beginning to change as more ED physicians are adding addiction services, including starting patients on the widely effective anti-addiction medication buprenorphine, the Washington Post reports.

The trend is taking hold in Maryland, with dozens of hospitals either treating or planning to treat opioid patients with the treatment, which has been shown to be more than twice as effective as non-medication therapies at helping those with substance use disorders quit, the Washington Post said. As part of this care strategy, these physicians also are briefly holding the patients for observation and making next-day appointments for them at local treatment centers.  

While most emergency physicians don’t have licenses to prescribe this narcotic (it requires eight hours of clinical training), physicians without a Drug Enforcement Administration license can administer a single dose of the medication to a patient within a 72-hour period under legislation known as the three-day rule, the publication said. Once patients are stabilized, they can get a monthly prescription for the medication from any primary-care doctor who has a DEA license.

Buprenorphine has the potential to greatly mend the opioid epidemic, but needs to be more accessible and affordable, said Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University in Waltham, Mass.

“If this movement in Maryland and other states is successful and starts to become normalized nationwide, it could change everything,” he told the publication.

Rural hospital closings have significant impact on health 

Approximately 90 rural hospitals have closed in the past eight years and others are facing challenges, resulting in dramatic health implications for residents, the New York Times reports. These include maternity care deserts, increased travel time for trauma cases, lack of access to behavioral and substance use specialists and more. These hospital closings, which appear to be linked to some states’ decisions not to expand Medicaid as part of the Affordable Care Act, often have rippling economic impacts, such as regional income dips and unemployment-rate hikes, the publication said.

In the ongoing conflict within some states about whether or not to expand Medicaid, “hospitals’ futures hang in the balance,” Richard Lindrooth, a professor at the University of Colorado School of Public Health, told the publication.

VA partnership to integrate behavioral health considerations in primary care

The National Science Foundation is funding a pilot program between the Department of Veterans Affairs and the behavioral health platform technology company NeuroFlow that would integrate behavioral health into the VA medical setting via remote monitoring. A Forbes op-ed says the technology could impact how VA physicians prescribe medications such as antidepressants and opioids and might also streamline paperwork and appointments for physicians and patients. 

NeuroFlow has already been adopted by 112 clinics and hospitals in five countries, the publication said.  

Small drug player step closer to possible market disruption

Esperion Therapeutics, a relatively small biotech company, is getting closer to attaining Food and Drug Administration approval for a pill called bempedoic acid, which is expected to lower cardiovascular patients’ cholesterol more cheaply and do it less invasively than competing products, Stat News reports. 

The pill, which the publication said is expected to win FDA approval and hit the market in 2020, would be an alternative to injected treatments designed for patients with extreme cardiovascular issues. While bempedoic acid is still in the process of proving its health benefits, some of which are predicted to work differently than its competition, 
Esperion plans to offer it at half the cost of rivals’ products.

This comes as Esperion’s would-be competitors are already lowering their prices as part of a deal with Express Scrips.