Video length: 3:09
[Music and sirens]
Andrew Herring, M.D. speaking:
I started out in emergency medicine and that's where I remain and that's where my heart is.
Self-referral defines what I treat. So if you walk in with a heart attack, I learn how to take care of heart attacks.
If you walk in with, you know, arthritis, I learn how to take care of arthritis.
The emergence of the opioid epidemic drove this problem into the emergency department.
Okay... What can I do to take an individual just to make them one objective notch less in harm's way?
The first step is just to treat the withdrawal. I'm hopeful.
I think a lot of us are around buprenorphine, in particular, it can have a dramatic reduction in overdose deaths.
The beauty of buprenorphine is it's incredibly safe. It is replacement, its opioid substitution treatment.
The medicine is very long acting. So it just sits there on the receptor giving this light signal so you don't feel withdrawal.
You don't feel craving, but you also aren't getting high.
The vast majority of our patients are treated just like this... sitting in a chair.
We do the physical exam, where you are trying to quantify how much withdrawal is going on and we initiate the medication.
That's it. And then we observe. The vast majority of folks will feel within 20 minutes much, much better.
That's when you can have a collaborative transparent discussion about... ok... where do we want to go from here?
A very large study found that patients who were given a brief intervention screening and referral to treatment, combined with buprenorphine, had nearly 80% retention and treatment at 30 days.
So from an addiction standpoint, that would be considered a spectacular success.
My message, is that the individual physician, you do not need to become addiction boarded.
You don't need to understand every aspect of long-term treatment.
We have a chance to drastically alter the trajectory of this epidemic, which right now is going in the wrong direction.
My greatest goal would be to have someone go from being homeless, using unclean needles and shooting heroin, to completely stable on buprenorphine.
There are clearly some patients for whom this medicine is as close as we have to a cure.