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As overdoses skyrocket, emergency departments deploy life-saving strategies

(DECADE OF DEATH: This is one in a series of reports on the borough’s opioid crisis.)

STATEN ISLAND, N.Y. -- Some agree to get counseling and treatment and others want out of the hospital as soon as possible.

Treating those with addiction who end up in the Island’s emergency departments is a challenge that health experts are tackling in new ways.

As the opioid epidemic has evolved, that role has greatly expanded.

In 2008, there was a rate of 391 opioid-related emergency department visits per 100,000 people in New York, but by 2016 that rate had increased to 1,029, according to the latest data available from the Healthcare Cost and Utilization Project (HCUP).

HCUP is part of the U.S. Department of Health and Human Services, and tracks hospital data.

Dr. Harry Kopolovich, the Director of Richmond University Medical Center’s (RUMC) Emergency Department in West Brighton, said that, ideally, patients don’t come to the ER for primary care of their addiction, but staff in the department are always prepared to connect them with the next step in their treatment.

Staten Island doctors and nurses in the borough’s emergency departments have acted as a vital part of the fight against opioid abuse.

Dr. Nicole Berwald, Chair of Emergency Medicine at Staten Island University Hospital (SIUH), said the emergency department staff deals with all levels of people dealing with a substance abuse disorder.

A ‘SAFETY NET’

From people seeking treatment options to the most urgent cases of people suffering life-threatening overdoses, nurses and doctors in the emergency room need to be prepared for a wide spectrum of patients.

“It’s really our responsibility to be alert of the situations that are going on, and be armed to take care of whatever a patient comes in with,” Berwald said.

“We consider ourselves the safety net of the healthcare system, so to not be able to address whatever level of concern related to opioids that exists would not be doing the right thing.”

DIFFICULT NEXT STEP

ER staff find that for many patients, especially those who come to the hospital involuntarily for an overdose, taking that next step in treatment can be difficult, Kopolovich and Berwald said.

“Overdose victims can be standoffish about getting help,” he said. “They want to get the hell out of there (the hospital) as quickly as possible.”

That’s why, Kopolovich said, empathy is the most important tool when treating someone with a substance abuse disorder.

“We don’t want anyone to feel like they’re going to get chastised for looking for help,” he said. “We want them to know our doors are open.”

Many of Kopolovich’s medical colleagues working on Staten Island, also call the borough home, so they’ve become familiar with the effects substance abuse have had on the community.

“For too long we’ve tried to medicalize this disease,” Kopolovich said of substance abuse disorders. “It’s time to take a bit of a step back and realize this could be somebody’s brother, cousin, or father.”

Both doctors said that treatment for an opioid use disorder needs to be done on a case-by-case basis analyzing the need of each individual patient.

TREATMENT WITH MEDICATION

While long-used tools for treatment like methadone and those used to address the symptoms of withdrawal are still in use, newer medication like buprenorphine have proven to be effective in some patients.

Buprenorphine is an opioid-based drug that reduces withdrawal risks. It along with methadone, and naltrexone, which blocks the effects of opioids, have become a part of the Medication-Assisted Treatment (MAT) approach, which aims to combine behavioral therapy with medications, according to the Substance Abuse and Mental Health Services Administration.

Kopolovich stressed that whatever the approach to treatment is needs to be decided by the physician attending to the patient. A divergence from that was one of the greatest contributors to the nation’s opioid epidemic, according to Kopolovich.

THE ISSUE OF PAIN

In 2001, the Joint Commission, which was known as the Joint Commission on Accreditation of Healthcare Organizations at the time, issued standards to improve care for patients in pain, according to a 2017 report from the non-profit organization that accredits healthcare facilities.

"For over a decade, experts had called for better assessment and more aggressive treatment, including the use of opioids," the report reads.

“Many doctors were afraid to prescribe opioids despite a widely cited article suggesting that addiction was rare when opioids were used for short-term pain,” according to the report.

Those standards were part of a broader push to treat pain levels as the “fifth vital sign” along with things like blood pressure, pulse, body temperature and respiration rate.

“They wanted no one having any discomfort whatsoever,” Kopolovich said. “People deserve to be treated fairly uniquely, but I think ultimately at the end of the day, the decision on what medication to prescribe should be dictated by the person with the most knowledge and the most clinical experience.”

Kopolovich noted that the number of patients coming to RUMC’s emergency department for overdoses peaked around 2017, and had since seemed to decline.

“It’s not that these things have gone away, but, thankfully, we’re not seeing the same numbers we had,” he said.

He also warned that even if opioid overdoses have begun to decrease, some other drug will inevitably take its place.

RUMC’s ER has begun to see more visits for marijuana use, which dealers sometime adulterate with PCP, Kopolovich said, noting the push for legalization is of particular concern to him.

“While narcotics are going away, the next recreational drug is right around the corner,” he said. “There’s a significant gap between the individuals making policy and the individuals implementing those policies.”