BALTIMORE _ For Dr. Zachary Dezman, an emergency physician in this heroin-plagued city, there's no question that offering addiction medicine to emergency room patients is the right thing to do.
People with a drug addiction are generally in poorer health than the rest of the population, he explained. "These patients are marginalized from the health care system. We see people every day who have nowhere else to go.
"If they need addiction medicine _ and many do _ why wouldn't we give it to them in the ER? We give them medicine for every other life-threatening disease."
But elsewhere in the country, all but a few emergency doctors and hospital administrators see things differently. They worry that offering addiction services could attract even more drug-seeking patients than they already see, taking up valuable staff time and beds, said Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University.
Instead of providing anti-addiction medication, most hospitals typically give ER patients with drug-related conditions the telephone numbers of local treatment clinics, he said.
Despite a raging drug overdose epidemic that is killing nearly 200 Americans every day and sending thousands more to emergency rooms, the vast majority of the nation's more than 5,500 hospitals have so far avoided offering any form of addiction medicine to emergency patients.
That's starting to change.
In Dezman's ER at the University of Maryland Medical Center Midtown Campus in West Baltimore _ and in 10 other Maryland hospitals _ addiction services, including starting patients on the highly effective anti-addiction medication buprenorphine, is a new and growing emergency service.
Similar services are planned for emergency departments in 18 more Maryland hospitals, according to Marla Oros, president of Mosaic Group, a management consulting firm that is providing technical assistance to the state's hospitals.
Approved by the FDA in 2002 for the treatment of opioid addiction, buprenorphine has been shown to be more than twice as effective as non-medication therapies at helping opioid users quit. Taken daily by mouth, the narcotic medication eliminates withdrawal symptoms and drug cravings, allowing users to feel normal without producing a high.
A 2017 study by researchers at Yale School of Medicine found that opioid-addicted patients who were given an initial dose of buprenorphine in an emergency room were twice as likely to be engaged in treatment a month later compared with those who were given only referrals to addiction treatment specialists. Lead author Gail D'Onofrio wrote in an email to Stateline that the practice is spreading.
Still, a 2017 survey by the American College of Emergency Physicians showed that only 5 percent of emergency doctors work in hospitals offering the anti-addiction medications buprenorphine or methadone, and 57 percent said that detox and addiction treatment facilities outside of the hospital were "rare or never accessible."
Dr. Eric Weintraub, an associate professor of psychiatry at the University of Maryland School of Medicine, was an early adopter of buprenorphine in the ER and is now helping spread the concept to other hospitals.
Starting in 2003, he initiated patients on buprenorphine in the psychiatric ER at the University of Maryland Medical Center in downtown Baltimore, and said he found it very effective at allowing patients to feel normal again and start thinking about treatment.
In general, Weintraub said in an interview, "We've learned that certain places are conducive to engaging patients in treatment. One of them is the ER. The other is the criminal justice system. We need to grab those opportunities and offer patients effective treatment when they're ready."
