For Zachary Dezman, an emergency physician in heroin-plagued Baltimore, there is no question that offering addiction medicine to emergency room patients is the right thing to do.
People with a drug addiction are generally in poorer health than the rest of the population, he said. "These patients are marginalized from the health care system. We see people every day who have nowhere else to go.
"If they need addiction medicine … why wouldn't we give it to them in the ER? We give them medicine for every other life-threatening disease."
But most emergency doctors and hospital administrators see things differently. They worry that offering such services could attract more drug-seeking patients, said Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University.
Instead of providing anti-addiction medication, many hospitals give ER patients with drug-related conditions the telephone numbers of treatment clinics, he said.
Despite a drug epidemic that is killing nearly 200 Americans every day and sending thousands to ERs, the vast majority of the nation's more than 5,500 hospitals have so far avoided offering any form of addiction medicine to emergency patients. That's starting to change.
In Dezman's ER at the University of Maryland Medical Center Midtown Campus — and in 10 other Maryland hospitals — addiction services, including starting patients on the highly effective anti-addiction medication buprenorphine, is a new and growing emergency service.
Similar services are planned for emergency departments in 18 more Maryland hospitals, said Marla Oros, president of Mosaic Group, a management consulting firm that is providing technical assistance to the hospitals.
Approved by the Food and Drug Administration in 2002 to treat opioid addiction, buprenorphine has been shown to be more than twice as effective as non-medication therapies at helping opioid users quit. Taken daily, the narcotic medication eliminates withdrawal symptoms and drug cravings, allowing users to feel normal without producing a high.
A 2017 study by Yale researchers found that opioid users who were given an initial dose of buprenorphine in an ER were twice as likely to be engaged in treatment a month later compared with those who were given only referrals to addiction treatment specialists. Still, a 2017 survey by the American College of Emergency Physicians showed that only 5 percent of emergency doctors work in hospitals offering the medications buprenorphine or methadone, and 57 percent said that outside detox and treatment facilities were "rare or never accessible."
"If this movement in Maryland and other states is successful and starts to become normalized nationwide, it could change everything," Kolodny said. "If you really want to see overdose deaths come down in the United States, getting treatment with buprenorphine has to be easier and cheaper than getting heroin and other opioids on the street."