ED intervention for drug abusers who overdose
Project POINT – Planned Outreach, Intervention, Naloxone and Treatment – is Indianapolis-based Eskenazi Health’s response to the surge in emergency department (ED) patients who have overdosed on heroin or other opioids.
Funded by the Eskenazi Health Foundation and the Richard M. Fairbanks Foundation, the two-year pilot program provides counseling to overdose patients, connects them to community resources to assist in recovery, and sends them home with naloxone (also called Narcan), an antidote drug that can pull victims of opioid overdoses back from the brink of death. The program also provides rapid testing for Hepatitis C to stem the spread of the disease among intravenous drug users.
Project POINT aims to end the cycle of addiction that afflicts Indianapolis and cities across the country. When drug users overdose, emergency medical responders save them by administering naloxone as a nasal spray and send them to the ED to be screened and stabilized for a few hours. When discharged, they return to using drugs and the cycle begins again.
Naloxone blocks the brain receptor that opiates latch on to and helps the body “remember” to take in air. But it’s no cure for heroin addiction.
“You can’t just sprinkle naloxone on everyone and think this will get better,” says Krista Brucker, M.D., an emergency care physician who helped create Project POINT.
The program focuses on reaching drug users at a time when they are most vulnerable – right after their habit has almost cost them their lives. Lying in the ED after being revived is an “intervenable moment” when addicts are most receptive to change, Brucker says.
“Patients don’t need much in the way of acute medical treatment if they are stable and awake and talking to you,” she says. “The question is what can we do to intervene in the long term in the course of the disease? It was important for the care team in the ED to find the things that we could do for them.”
Project POINT’s “Recovery coaches,” who have been drug users in their own lives, visit patients at their bedside in the ED and provide follow-up assistance. Clinicians and coaches stress education, prevention and a continuum of care.
“This is a chronic disease that needs to be managed, like the way we treat a patient with heart disease,” says Brucker, who adds that most of the drug users who show up in her ED are looking for help. But she notes that a lack of treatment facilities in the area pose a challenge for both the hospital and its patients.
"We are trying to make a resource-constraint system function at its highest capacity," she says.
Project POINT has reached more than 270 patients since it began in February 2016. About 25% of the program’s enrollees stick with the program for at least six months. Brucker says the counseling, treatment and social services can lead to stable housing and employment and a better chance of recovery for many who participate in the program.
But kicking the heroin habit is hard. “Even our very first patients are still in a fragile place in terms of their addiction,” Brucker says. “This is a long-term chronic disease.”
Without follow-up care, drug users are likely to keep feeding their habits, putting them at risk of another overdose – possibly one that could kill them.
In 2015, according to the Centers for Disease Control and Prevention, heroin deaths alone surpassed gun homicides for the first time. More than 33,000 people died of opioid overdose, with another 20,000 dying from other drugs.
The President’s Commission on Combatting Drug Addiction and the Opioid Crisis on July 31 recommended the President declare a national emergency on drug overdoses. The commission said more than 140 Americans are estimated to die every day from drug overdoses.
Making headway on the problem means treating heroin addiction as a public health issue and not a moral failing, Brucker says.
“We say to our patients that no matter where you are, no matter what happens, you can call us and we will do everything we can to help you,” she says. “I can point to people who would be dead without this program … and there are so many more out there who are still using heroin every day, and we want them to know that they are worthy human beings whose lives matter.”