Yes, Yes, Yes!

by Anna Arroyo Plasencia, MD, SFHM

You have probably already seen SHM’s Action Alert, Crisis in the Mental Health System.  I would have missed this item if a colleague hadn’t mentioned it, though, this could not have come at a better time. America’s mental health system is broken!

As hospitalists, we are constantly asked to care for patients whose medical illnesses are complicated by their mental ones. This could not be truer than for addiction.  A colleague recently asked me to provide a curbside consult for a psychiatric boarder she was treating for alcohol and opioid withdrawal. Interestingly, I was also this patient’s admitting hospitalist the week before.

In addition to my day job in hospital medicine, I am a medical toxicologist and an addiction medicine specialist. My background provides a unique opportunity for me to become involved in patient care through management of the consequences of overdose. I am also qualified to assist in the outpatient setting when patients are on their road to recovery. Lastly, I am also asked by my hospitalist colleagues to help with the inpatient treatment of addiction, as with the patient presented here.

This patient is a perfect example of whom this action alert is trying to help.  While his ethanol withdrawal was being medically managed, his opioid addiction and his other concurrent mental illnesses were not. Addiction is becoming a frequent comorbid medical issue affecting hospital medicine patients.

According to the 2013 National Survey on Drug Use and Health, there were an estimated 24.6 million current illicit drug users age 12 and older in the United States, accounting for 9.4% of the population. This increased with the 2014 survey to an estimated 27 million current illicit drug users age 12 and older. This current estimate corresponds to about one in ten Americans being affected. While this incorporates trends in marijuana use, nonmedical prescription pain reliever use continues to be the second most common type of illicit drug use in the United States. However, addiction does not end here.

According to data from the CDC, heroin use has increased across the Unites States and the heroin epidemic has been associated with a nearly four times increased rate of heroin-related deaths when compared to prior years. This epidemic has not shown signs of slowing.  With the combined increase in the use of nonmedical prescription pain relievers and the increase in heroin use, hospitalists are caring for a growing number of patients with opioid addiction.

The Helping Families in Mental Health Crisis Act of 2015 (H.R. 2646) is a start to addressing this issue.  Locally, we are opening an addiction medicine clinic and have added a lecture on addiction medicine to our chapter’s scheduled meetings in 2016. I encourage you to support this initiative and to look for ways to increase addiction awareness in your communities.

After supporting SHM’s Action Alert, Crisis in the Mental Health System, you can review the campaigns sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) for information, training, and technical assistance with improving addiction services in your community. SAMHSA’s Screening, Brief Intervention, and Referral to Treatment (SBIRT) campaign provides hospitalists with tools for everyday practice. SBIRT can be used to:

  • Quickly screen the severity of substance use
  • Provide a focused intervention to increase patient insight and awareness into their addiction while motivating change
  • Provide an opportunity for specialty care recommendation

SAMHSA also provides resources for treatment referral, supports an Opioid Treatment Program Directory and a Buprenorphine Treatment Physician Locator service that can be used to find programs in your community. You can also find a similar resource through the American Society of Addiction Medicine. Now you have some tools and programs to guide your patients on their road to recovery.

Dr. Anna Arroyo Plasencia, SFHM is a hospitalist and medical toxicologist at Washington University School of Medicine in St. Louis, Missouri. In addition to Internal Medicine and Medical Toxicology, she is board certified in Pediatrics and Addiction Medicine and serves as co-director of a toxicology and addiction medicine clinic. Dr. Arroyo Plasencia completed her residency in Internal Medicine and Pediatrics and fellowship in Medical Toxicology at Indiana University School of Medicine. In her free time, she enjoys traveling and spending time with family.

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