The CDC estimates 115 people die of opioid overdose every day. Those that make it to the entrance of the EDs may arrive in large numbers, creating occupational threats of drug exposure or violence to healthcare workers trying to deliver care.

In data reported from July 2016 through September 2017, the CDC found that ED visits in 45 states showed that opioid overdoses are increasing across all regions.

“Out of 91 million emergency department visits, there were 142,557 suspected overdoses involving opioids,” Anne Schuchat, MD, CDC acting director, said at a recent news conference. “Opioid overdose emergency department visits increased about 30% overall in this national system. We saw increases in cities and towns of all types from the third quarter 2016 to the third quarter 2017.”

The toll of the opioid epidemic has reached unprecedented levels, with an estimated 63,000 overdose deaths in 2016, the CDC recently reported.

“We’re currently seeing the highest drug overdose death rates ever recorded in the United States, driven by prescription opioids and by illicit opioids such as heroin and illicitly manufactured fentanyl,” the agency reported.

As previously reported in Hospital Employee Health, there have been hospital workers, first responders, and police officers overwhelmed by narcotic exposures in dealing with opioid users and overdosed patients. Some of this is thought to occur because street drugs are being cut with powerful synthetic opioids, some many times more potent than anything typically used in a hospital.

In addition, EDs crowded with people under the influence of opioids raises the concern about patient violence toward healthcare workers. There are threats for violence even in the absence of drugs, as evidenced by a recent report from an ED in Florida.

“I’ve seen a lot in my career as a field director [for The Joint Commission] but I won’t soon forget the night when members of rival gangs presented in our ED trauma center,” Jim Kendig, MS, CHSP, CHCM, CHEM, LHRM, wrote in a Joint Commission blog post.1

The situation resolved without incident, but there were several follow-up meetings and discussions about ED safety.

While the opioid epidemic contributes to violence, will it also be a siren call to addicted healthcare workers? The opioid epidemic overlaps with the longstanding problem of addicted healthcare workers diverting drugs such as fentanyl from patients.

“For every fatal case there are many more nonfatal cases, each one with its own emotional and economic toll,” Schuchat said. “Research shows that people who have had at least one overdose are more likely to have another.”

The CDC is working with hospital EDs to refer these surviving addicts for subsequent treatment. “Take steps toward preventing a repeat overdose, ideally [by] alerting community partners to opportunities to improve prevention in the surrounding areas,” she said.

On a personal note, U.S. Surgeon General Jerome Adams, MD, MPH, said his brother has struggled with addiction for decades. “I often contemplate the fact that it could have been me,” Adams said at the press conference. Getting the opioid antidote naloxone in the hands of first responders and community members is an immediate priority, followed by public education and destigmatization of addiction, he added.

REFERENCE

1. Kendig, J. Lessons Learned: Rival Gang Members in the Same Hospital. The Joint Commission blog, Jan. 4, 2018. Available at: http://bit.ly/2GlCfk4.