How Maryland's lengthy ER wait times could be deadly for addicts
Emergency room patients in Maryland can expect the longest wait times in the country. This could be detrimental to the health —and lives — of many patients, including addicts.
For those needing potentially life-saving medical treatment, facing long wait times in the emergency room can be a nightmare — especially in Maryland.
The state turns out to have the longest emergency room wait times in the country, averaging 8 hours, WYPR reported Wednesday, citing a report by the Maryland Health Services Cost Review Commission. The shocking number is actually an improvement over the average 11-hour wait reported earlier this year.
And while those hours could feel like days to patients seeking care for severe injuries and ailments that require high levels of care, another group is bound to suffer: addicts.
The danger posed by substantial delays in treatment to those suffering from substance use disorder, particularly amid the opioid epidemic, is multipronged.
Perhaps the most severe addiction-related emergency is a drug overdose, which nowadays is often related to the use of fentanyl, a synthetic opioid significantly stronger than heroin.
First responders, of course, can use naloxone to reverse overdoses. Thanks to increased access in recent years, everyday citizens can also purchase and carry the life-saving drug.
However, reviving someone with naloxone is not the end of the story.
In many cases, patients also must be monitored by professionals such as those in emergency rooms to ensure the overdose symptoms don’t return and cause further health complications.
“People who are given naloxone should be observed constantly until emergency care arrives,” according to the National Institute on Drug Abuse. “They should be monitored for another 2 hours after the last dose of naloxone is given to make sure breathing does not slow or stop.”
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Overdoses or drug and alcohol toxicity aside, withdrawal from substances also often requires emergency medical attention.
In the case of alcohol and benzodiazepine withdrawal in particular, seizures and other complications can kill someone without prompt medical attention.
Heroin addicts also may face debilitating withdrawal symptoms that can be curbed in emergency medical settings via methods such as the administration of buprenorphine.
And that’s if the hospital even offers medically assisted treatment services, which are underutilized by many facilities despite being incredibly effective.
“One nationally representative observational study found that visits to the (emergency department) increased for both alcohol use disorder and substance use disorders more generally between 2014 and 2018, making up 1 in 11 ED visits and 1 in 9 hospitalizations overall.,” reported Health Affairs, a peer-reviewed health care journal. “The increase in addiction-related ED visits coupled with the growing evidence base for the effectiveness of (medically assisted treatment), means that addiction treatment can no longer be a niche industry operating on the fringes of the fractured health care system.”
In both these scenarios, patients struggling with addiction and its effects can't afford to wait. Their life may depend on timely treatment.
As noted by WYPR, “long emergency room wait times are associated with an increased risk of death and a higher likelihood of being admitted to the hospital,” putting even more strain on hospital staff.
That’s extremely problematic considering a lack of staffing in hospitals is already a widespread issue that was exacerbated by the COVID-19 pandemic.
McKinsey & Company, an international management consulting firm, estimated in June that there was a potential shortage of 200,000 to 450,000 nurses in the U.S., with acute care positions being the most impacted.
Perhaps as a result of those staffing issues, many hospitals in the state also lack addiction-related programs, according to data gathered by the Maryland Health Services Cost Review Commission.
Based on community health needs assessments submitted by Maryland’s hospitals, less than half reported having behavioral health initiatives related to substance abuse.
Even fewer have initiatives addressing addiction-related health conditions, with only one-third reporting they had such a program in place.
A lack of hospital programs further harms addicts, as there are already barriers to accessing rehabilitation facilities in general, leaving some who are seeking help to be put on a waitlist.
Given the efficacy of treatment in an emergency department, not being able to access those resources only increases the likelihood of substance abuse being a death sentence.
Health Affairs emphasized the importance of emergency departments having the programs, arguing that “no other setting is able to replicate the all-hours access and wrap-around services of an ED.”
“Without a (medically assisted treatment program), many patients who present to the ED post-overdose or seek help for addiction are turned away or faced with a ‘treat them and street them’ approach,” the journal stated. “One recent study shows that fewer than 20 percent of patients in need receive medication treatment for opioid use disorder, despite strong evidence that medication can be effective in reducing overdoses and overall mortality for OUD.
“Incorporating patient navigators into an ED to work with patients with substance use is also a successful strategy for initiating treatment in this setting.”
It’s important to note that when an addict is in the emergency room experiencing crippling withdrawal or the after-effects of an overdose, going there oftentimes wasn’t their first choice.
Seeking help, whether in the emergency room or a rehabilitation facility, is for many an incredibly difficult thing to do. Many would prefer to try to ride out the symptoms and take the risk.
Others would just continue to use.
In a nation where health care costs bankrupt its citizens, someone living under the current system should expect and demand effective and timely treatment when they are in dire need of care.
Whether an addict or not, everyone should at least be at ease knowing they have the option.