ER patients treated for addiction-related emergencies would receive more support under Indiana bill
After her daughter was born in 2014, Rebekah Gorrell started experiencing postpartum depression. She was afraid to talk with her doctor about it, for fear her child would be taken away.
So she started to self-medicate — first with opioid pills like OxyContin, eventually moving to heroin.
In 2015, she had a near-fatal overdose. It took several doses of naloxone — an opioid overdose reversal drug — to revive her that October day. She was taken to a nearby hospital in Indianapolis, where she lives, for four hours of observation.
Gorrell said the experience was an awakening — she was scared and worried about her daughter.
“It was eye-opening, but people with substance use disorder are sick,” she said. “And after that brief window passes, the next thing you’re thinking about is how to get rid of the craving of wanting to use more.”
Looking back, Gorrell said she may have been open to recovery options, like peer support.
But the hospital didn’t provide her or her family any information on resources, and Gorrell said she felt stigmatized by the people who treated her.
Within an hour of getting home, she said she started using again to fight off the rapid withdrawal the naloxone had sent her into because she “didn’t know what else to do.”
Gorrell said that hospital has since implemented plans to intervene when a patient comes in with an overdose. So have some other hospitals in Indiana.
But some lawmakers and advocates say more is needed, and House Bill 1462 could provide that help to save lives.
It calls for emergency departments to evaluate their ability to respond to addiction-related emergencies and submit plans to the state for patient intervention annually.
This would include referring pregnant patients to the Indiana Pregnancy Promise Program or the 988 suicide and crisis line, and providing counseling and medication for patients with co-occurring mental health issues and substance use disorder.
The bill would also increase the number of providers who can do office-based opioid treatment, like medication, by removing a waiver requirement from the federal Substance Abuse and Mental Health Services Administration.
Doug Huntsinger, executive director for Drug Prevention, Treatment and Enforcement in Indiana has testified in support of the bill.
According to a state-commissioned study Hunstinger cited, in more than two-thirds of fatal overdoses in Indiana, the person had been treated at the ER for a nonfatal overdose within the previous three months.
“Our emergency departments are a critical intervention point, but only a handful have a comprehensive plan to address substance use disorder,” Huntsinger said during a recent state Senate committee hearing.
Supporters of House Bill 1462 say it could help prevent deaths. Bill author Republican Rep. Ann Vermilion, of Marion, said during a recent hearing the goal is not to have a one-size-fits-all approach. What works for a rural hospital might be different than one in a larger city.
“I didn't want that every hospital ER had to have a very specific plan,” she said. “We would love for them to evaluate their plan. [What] are they missing? What do they not have available to them?”
Some hospitals in Southern Indiana are already taking steps similar to those outlined in the bill.
Clark County Health Officer Dr. Eric Yazel, who also works in the ER at Clark Memorial Health, said that until several years ago, he didn’t have a great understanding of substance use disorder. But he saw troubling trends in the ER.
“Jeffersonville is still a small town,” he said. “I saw people I knew either personally, or sons of people I knew, or moms of people I knew. And I was like, ‘Something's wrong here, and what we're doing right now isn’t working.’”
The health department and hospital worked together to build out a comprehensive plan to respond after an overdose.
Yazel said after the person is stabilized, they’re assessed to see if they could be a good match for medication assisted treatment. Some staff can start that right away at the hospital, and Yazel said that number continues to grow.
Patients are given naloxone to take home, and there’s also afree vending machine dispensing the medication outside the emergency department. A peer recovery coach is there to talk with them during certain hours. The hospital can help connect patients to treatment after the hospital visit.
“Some of these things that we felt like we're really cutting edge three or four years ago really are what we consider standard of care now. Just the necessary response when you see a patient with substance use disorder,” he said.
Yazel said in the first year after the plans were put in place, overdose deaths in the county dropped around 40%.
Mike Schroyer, president at Baptist Health Floyd in New Albany, said patients who come in with an overdose or other substance-related emergency are given information on resources to follow-up with after initial care. In most cases, staff make the phone calls for the patients to help connect with treatment and other support. Staff are able to refer patients to outside specialists for medication assisted treatment.
Schroyer said the need for that intervention came from the frequency of overdoses ER staff was treating. He added that in the two-and-a-half years he’s been with Baptist Health Floyd, his team “has really worked hard to work with these patients and make sure that they are linked up with the appropriate resources and that they get what they need.”
Kari Thom Carter, a Jeffersonville mother, said she’s seen changes in local hospital response to addiction in recent years. Her daughter has been to hospitals in Southern Indiana and Louisville multiple times over the past decade — sometimes for overdoses, sometimes for other addiction-related issues, like sepsis or endocarditis.
“I feel like I’ve seen more compassion in these last few years in the emergency department,” Carter said.
She said she recently took her daughter to Clark Memorial Health to try to get medical clearance to enter a rehab program, and the hospital offered additional help.
“That was a good experience,” Carter said. “She rejected [the support], but they tried to do everything to keep her there and help her kind of detox and run more tests to help her get to the next step.”
Brandon George, vice president of Mental Health America of Indiana and executive director of the Indiana Addiction Issues Coalition, said it’s crucial for hospitals to have those plans and be able to help set up some of those treatment options.
He said it’s difficult for even therapists and social workers to navigate the system. It’s harder for people who aren’t familiar with it. “And then you add somebody who is under distress that may not have resources. They may not have transportation, they may not have stable housing, they may not have a telephone or internet,” he said. “Then it becomes really impossible. It goes from hard to hardly possible.”
After her overdose in 2015, Rebekah Gorrell used drugs for about another year. She’s now been in recovery for almost seven years and works as manager of the Indiana Recovery Network, a program of Mental Health America of Indiana.
Gorrell said she feels that could have happened a lot sooner if the hospital had offered more help. After all, she said, there are emergency protocols in place for other health issues, like heart attacks.
“And I just think it makes sense to have a protocol in place for individuals who are coming in experiencing an overdose,” she said. “We’ve got to keep people alive for them to find recovery.”
House Bill 1462 has been met with concerns by some lawmakers. Republican Sen. Liz Brown of Fort Wayne voted in favor of the measure in committee earlier this month, saying she did so because she knew there would be changes to it. Brown said parts of the bill seem burdensome to hospitals, and that staff can’t be responsible for patients after they leave their care.
“They're not the medical police. They’re medical physicians and providers,” she said. “So we can try to hook them up with services. But at the end of the day, it's no different than any other patient who comes into the hospital.”
For George, it comes down to saving lives. And he said he has no doubt that’s what the legislation would do.
“The question is just how many lives will it save? This will transform how we treat people with addictions in our hospital systems,” he said.
House Bill 1462 recently passed the Senate Committee on Health and Provider Services and was referred to the Appropriations Committee.
Coverage of Southern Indiana is funded, in part, by Samtec, Inc. and the Hazel & Walter T. Bales Foundation.
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