SOCIAL EM & POPULATION HEALTH
Mitigating the Harms of Opioid Misuse and Withdrawal by Expanding the EM Toolkit to Include Methadone and Harm Reduction By Natalie Strokes, DO, MS; Lauren Westafer, DO, MPH, MS; Bill Soares, MD, MS; and Elizabeth Schoenfeld, MD, MS, on behalf of the Social EM and Population Health Interest Group
SAEM PULSE | MARCH-APRIL 2024
The Case
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Your next patient is a 33-year-old female with a forearm abscess and cellulitis. She has endured a 10-hour wait in your waiting room due to current capacity challenges. Upon examination, she appears restless, anxious, sweaty, with notable goosebumps. Vital signs reveal a heart rate of 110 and a temperature of 100.2. She explains that she attempted to manage the abscess at home with warm compresses, but it has worsened over the past three days. She discloses injecting heroin/fentanyl into that area about 5 days ago. She mentions experiencing pain all over, along with recent nausea and diarrhea. Notably,
her medical record indicates a similar presentation a year ago when she left against medical advice (AMA) despite being tachycardic and febrile at that time.
The Discussion
In addition to treating her cellulitis, what additional care does she require? What resources does your emergency department (ED) have to increase the likelihood that she stays for her needed antibiotics? How can you reduce her risk of bacterial endocarditis and overall improve her health while decreasing mortality? Managing patients with opioid use disorder (OUD) can be challenging. These patients can be
medically, socially, and emotionally complex, often with priorities misaligned with the health care team. Despite this, the health risks they face are clear: ED patients presenting with a nonfatal opioid overdose have a 1-year mortality of 5.5%, comparable to patients admitted for NSTEMI. Those in withdrawal, presenting with injectionrelated infections or opioid withdrawal alone, are frequently offered marginally effective treatment, increasing their likelihood of leaving AMA and hindering future access to medical care during episodes of illness or withdrawal. The burden of OUD-related infections is substantial, with OUD-related infections