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The opioid crisis is well publi­cized and widespread nation­ally. Every day, the media reports dangerous trends in overdose-related deaths (Katz, 2017). It is estimated that more than 18,000 deaths in 2014 were due to opioid overdoses, a leading cause of accidental death in the United States (Papar­ella, 2014). Many of us who work in health care have experi­enced this issue first­hand, as we work with patients daily who are living with opioid use disorder (OUD). Often, these inter­ac­tions are frustrating for health­care profes­sionals and patients, with both feeling helpless. Opioid use disorder is often misun­der­stood as a social or moral issue instead of as a chronic illness.

Conse­quently, health care profes­sionals are not trained on the causes and evidence-based treat­ments of OUD. This educa­tional gap among health care profes­sionals leaves patients feeling they are not respected; they feel treated poorly as well as judged. This leaves the patient who came to seek treat­ment feeling angry and the health care profes­sional feeling helpless. This lack of coordi­nated care continues and leaves a vulner­able popula­tion in our commu­ni­ties with deadly consequences.

In 2015, there were 718 opioid overdose related deaths in Washington state (DOH, 2017). The following year, the Centers for Disease Control and Preven­tion released new guide­lines for the treat­ment of chronic pain (Dowell, Haegerich and Chou, 2016). Washington state Governor Jay Inslee wrote an execu­tive order outlining a statewide opiate response plan (Inslee, 2016). The two documents parallel each other, acknowl­edging that our previous focus on simply reducing the number of opiate prescrip­tions was not enough. In fact, research indicates such an approach actually causes harm, removing a patient’s legal access to a substance on which they depend physi­cally and emotion­ally. Without proper medical support, patients turn to illicit forms of the drug. Since imple­men­ta­tion of the statewide prescrip­tion monitoring program in 2012, a decrease in prescrip­tion-related police arrests, treat­ment-seeking and mortality have been achieved. Banta-Green and Williams (2016), however, identi­fied that heroin-related incidents have increased in all three areas proportionately.

An appro­priate and effec­tive response to opioid use disorder and its related deaths must also include a concerted focus on preventing overdose, increasing access to overdose reversal agents, and expanding options for, and access to, treat­ment of the disease.

The emergency depart­ment at St. Clare Hospital was once consid­ered a small, commu­nity hospital; however, we have grown into a large ED, treating 120 – 150 patients daily. The ED at St. Clare serves as a crucial daily resource for the many patients we see with life-threat­ening illnesses and urgent primary care needs unmet by the overbur­dened system. Many of our patients live with untreated OUD, and for some we are their only contact with medical care. Histor­i­cally, EDs have not been viewed as the arena to treat or resolve this chronic issue; however, at St. Clare, we believe in another philos­ophy. These individ­uals, frequently stigma­tized in other settings or refused pain manage­ment, arrive to our depart­ment because they need under­standing and relief of their symptoms, which we can provide. Our patients need kindness, under­standing, pain control and options for medical treat­ment, such as buprenor­phine and naloxone sublin­gual film.

Naloxone is an opioid reversal agent that can be used when a patient has used an excess of opioids. It does not replace the need for a health care practitioner’s care, but it can and should be used in homes and commu­ni­ties for immediate response to life-threat­ening or suspected overdoses. Naloxone is easy to use and comes in auto-injector or intranasal kits, similar to an insulin pen or an epineph­rine auto injector system. The American College of Emergency Physi­cians (ACEP) and the Washington State law RCW 69.50.315 recom­mend that anyone at risk of having or witnessing an opioid overdose be given naloxone and trained to use it (ACEP, 2015). This trans­lates to our patients who use heroin; have signif­i­cant daily doses of opioids prescribed; or recently under­went a period of absti­nence or reduced use secondary to treat­ment, incar­cer­a­tion or hospi­tal­iza­tion. Such patients, as well as their friends and family, should be receiving this drug free of charge.

St. Clare Hospital is working toward this goal. Nurses, pharma­cists, physi­cians and admin­is­tra­tive leader­ship have been meeting to develop a protocol to dispense a naloxone kit” to at-risk patients upon discharge. This kit would include the medica­tion, simple instruc­tions for use and educa­tional materials on safer opioid use and overdose preven­tion. This kit will be given following an in-person, one-to-one educa­tion session with a trained member of our health care team. We are committed to reducing the harm associ­ated with opioid use disorder in our commu­nity. This means reducing overdose-related deaths. It also means providing the staff with the tools to truly help their patients, and to demon­strate to our patients that we believe their lives are worth saving.

American College of Emergency Physi­cians, Board of Direc­tors. (2015, October). Naloxone Prescrip­tions by Emergency Physi­cians. Retrieved August 12, 2017, from https://​www​.acep​.org/Clinical — Practice-Manage­men­t/­Naloxone-Prescrip­tions-by-Emergency-Physi­cians/

Bandta-Green, C., Phd MPH MSW, & Williams, J., PhD. (2016). Overview of opioid trends in Pierce County. Alcohol and Drug Abuse Insti­tute, Univer­sity of Washington.

Dowell D, Haegerich TM, Chou R. CDC Guide­line for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR‑1):1 – 49. DOI: http://​dx​.doi​.org/​1​0​.​1​5​5​8​5​/​m​m​w​r.rr6501e1

Inslee, J. (2016). Execu­tive Order 16 – 09 (State of Washington, Office of the Govenor). Retrieved from http://​www​.governor​.wa​.gov/​s​i​t​e​s​/​d​e​f​a​u​l​t​/​f​i​l​e​s​/​e​x​e​_​o​r​d​e​r​/​e​o​_16-09.pdf

Katz, J. (2017, June 5). Drug Deaths in America Are Rising Faster Than Ever. The New York Times. Retrieved August 12, 2017, from https://​www​.nytimes​.com/​i​n​t​e​r​a​c​t​i​v​e​/​2​0​1​7​/​0​6​/​0​5​/​u​p​s​h​o​t​/​o​p​i​o​i​d​-​e​p​i​d​e​m​i​c​-​d​r​u​g​-​o​v​e​r​d​o​s​e​-​d​e​a​t​h​s​-​a​r​e​-​r​i​s​i​n​g​-​f​a​s​t​e​r​-​t​h​a​n​-ever.html

Papar­ella, S. (2016). A Tale of Waste and Loss: Lessons Learned. Journal of Emergency Nursing, 42(4), 352 – 354. doi: http://​dx​.doi​.org/​1​0​.​1​0​1​6​/​j​.​j​e​n​.​2​016.03.025

Opioid-related Deaths in Washington State, 2006 – 2016 (No. DOH 346 – 083). (2017). Washington State Depart­ment of Health. doi:http://​www​.doh​.wa​.gov/​P​o​r​t​a​l​s​/​1​/​D​o​c​u​m​e​n​t​s/Pubs/346 – 083-SummaryOpioidOverdoseData.pdf