“Please don’t discharge him,” pleaded the mother of a 16-year-old patient who had taken an overdose of prescription opioids and received my care in the intensive care unit (ICU). As an intensive care physician, most patients and families can’t wait to get out of my ward.this patient is physically Getting out of the intensive care unit was fine, but his parents and I knew that the underlying problem that brought him into the hospital—his substance use disorder—was not addressed. I had no choice but to send him on his way. That was nearly 15 years ago, and I think it was the height of the drug epidemic.
Estimated today 107,000 Americans Drug overdose deaths in 2021, according to provisional estimates just released by the Centers for Disease Control and Prevention. According to the 2020 National Survey on Drug Use and Health, Only 6.5% of the 41.1 million The person battling a substance use disorder received the necessary treatment in the previous year. This statement is all too common.
However, we find our country in the midst of a worsening opioid epidemic and, as it was decades ago, in a state of disorganized and disjointed care. This is because of the three main causes of the pandemic – physical, mental and financial suffering. Physically, some physicians have traditionally overprescribed opioids to their patients, fueled by drug company information. Mental factors include an increase in the prevalence of mental illness, driven by the isolation, stress and economic pressures of the Covid-19 pandemic.In the end, the widening gap between rich and poor plays a role, because research shows Those struggling financially are more likely to turn to substance use.
Now that we know the root causes of the opioid epidemic, why are we still here? It all revolves around shame. Stigma prevents access to evidence-based treatment. Imagine if only 10% of heart attack patients received clear evidence-based care – that would be an outrage. This is what is happening with people who are currently overdosing on opioids. Furthermore, stigma leads to a lack of equality. While the Mental Health Equity and Addiction Equity Act went into effect 15 years ago, insurers are required to cover behavioral health benefits to the same extent as physical health benefits, a recent report It was found that the law was not enforced. Finally, stigma leads to a lack of connection. Clinicians are often unable to share life-saving behavioral health data with other providers—whether they are practicing behavioral or physical health medicine—adding further to the lack of care coordination.
While this problem can easily be seen as insurmountable, there is a solution if we work together. First, we must meet with the individuals they are in and shift the focus to prevention. This work usually begins in our home or doctor’s office by first screening and identifying our own or our loved one’s behavioral health needs.Use free assessment tools such as Addiction Treatment Needs Assessment, both clinicians and consumers can assess the needs of their loved ones or their patients for substance use disorder treatment to support them in finding the right level of evidence-based care. In addition, through specific tools and platforms integrated into providers’ electronic health records, insights into an individual’s overall medical and behavioral health history, and analysis of medication use history, providers can quickly and efficiently understand an individual’s risk of overdose, helping them Make the right decisions for their individualized care needs.
With an in-depth understanding of individual needs, we must turn our attention to determining the appropriate type and level of evidence-based treatment. For example, if a doctor determines that one of their patients is currently struggling with a substance use disorder, then the doctor must know how to help their patient. In our current healthcare system, however, that’s easier said than done. Providers are often unaware of the treatment options available to patients, such as inpatient and outpatient treatment centers and providers specializing in mental health and substance use disorders. As a result, providers are unable to refer patients to the correct care, leading to major barriers to obtaining appropriate and timely care. today, Telehealth accounts for 36% of mental health and substance use visitswhile the bulk of physical health has returned to in-person care.
Much of these evidence-based treatments and access to necessary patient data rely on care coordination. Without care coordination, our nation’s healthcare system will continue to operate in silos that separate our bodies from our spirits. Integrating physical and mental health information into electronic medical records and other frequently used workflows at the point of care is critical to ensuring that primary care providers and clinicians across different specialties can make timely and appropriate referral and care decisions. For example, the use of electronic notifications can provide real-time alerts to providers when a patient is admitted, discharged, or transferred from a hospital. This means that a behavioral health or primary care provider can help with immediate follow-up care. Without this type of integration, a patient’s care team simply cannot communicate and deliver the right care to their patients at the right time.
Fortunately, we are starting to make progress. In July, if people have a behavioral health emergency, they will be able to call 988, similar to 911. Additionally, Congress and the Biden administration have recently funded behavioral health reforms and introduced bipartisan legislation. Using this momentum, we can continue this important work. By understanding the underlying causes of substance use disorders, de-stigmatizing mental health care, and working together to improve coordination of access to treatment and care, we can more adequately support individuals’ care needs before it’s too late.
Photo: Moussa 81, Getty Images
