Behavioral Health in the ED

Opioid addiction is a growing nation-wide concern. It has been declared a Public Health Emergency, and the worst drug crisis in American history. Opioid addiction has torn through the US, destroying lives in its path. Every day, emergency rooms treat over 1,000 people for misusing opioids.

Patients with mental health disorders are a vulnerable population and are more susceptible to develop a drug addiction. Today, patients with mental health disorders receive over 50% of the opioid prescriptions written each year. Studies have found that 19% of mental health patients have a prescription for an opioid, compared to only 5% of those without a mental health condition.

Improving pain management and care for this population is critical in the fight to reduce the opioid crisis. And telepsychiatry can help tackle critical issues in the race to reduce opioid abuse.

1. Psychiatrists identify patients with opioid dependence

With the rampant use of opioid abuse and opioid-related deaths, it’s crucial that health care professionals understand the intricacies of addiction. Studies have shown that understanding how mental health conditions are a contributing factor to addiction is foundational to the treatment of opioid addiction.

There is a high association between mental illness and opioid abuse. Some opioid addicts will only experience psychiatric symptoms while using a drug, while others will have comorbid conditions along with their addiction. Psychiatrists are in a unique position to identify and help these patients and also coordinate their care.

Telepsychiatry has an even greater advantage because it’s not limited by geography. Not every doctor is equipped to handle addiction patients, and it can be difficult for patients to find providers in their area who can treat addiction. This geographic limitation also becomes a cost issue when patients have to travel far to find a provider.

These factors do not limit telepsychiatry. A network of trained psychiatrists available via telemedicine means patients can find the right doctor for them, no matter where they are located.

2. Multiple prescriptions from multiple providers

Psychiatric medications can have dangerous side effects when taken with opioids. Detecting the simultaneous use of these medications is a health imperative for patients. Physicians should consider pharmacokinetics when addressing adverse events in patients who take opioids and psychotropics.

Psychiatric medications can also affect pain management. Patients who take psychotropics and an opiate for pain management may find that the psychotropic reduces the efficacy of the opiate. This reduction in pain management can lead the patient to increase their opiate dosage, sending them down a dangerous path.

Physicians who specialize in primary care or emergency medicine may not know all the side effects and adverse events related to psychiatric medications. On-call telepsychiatrists can quickly review medications to check for safety and side effects and advise if changes are needed.

3.   Treatment options for opioid abuse

There are many treatment options for opioid abuse, including medications such as buprenorphine and naltrexone. Pharmacological treatment by itself is often not enough to help patients overcome their addiction though. Medications should be combined with behavioral therapy, an approach referred to as Medication Assisted Therapy, or MAT. This technique addresses the patient as a whole, meeting their mental and physical needs to overcome addiction.

Psychiatrists specializing in addiction treatment and primary physicians can easily work together with telemedicine. 24/7 access to psychiatrists helps make sure patients don’t fall through the cracks and can get help when they need it, every time.

4. Coordinated care to treat addiction

The best evidence for treating opioid addiction indicates that regular follow-up care, psychosocial interventions, and promotion of medication adherence are all important for treatment to be successful.

Telepsychiatry can help accomplish this type of coordinated care. Patients receive easier access to primary providers and specialists, making long-term follow-up care possible. Telepsychiatry teams are specially trained in standard operating procedures for ERs and help to streamline communication and coordination. Board-certified psychiatrists can offer consistent, quality care, and timely access for patients via telemedicine.

5. Education about prescription opioids

The current opioid crisis has caused some physicians to improperly manage pain because of concerns about abuse. Psychiatric consultants can help set other physicians’ minds at ease and ensure these medications are used safely. Telepsychiatrists are always on-call to offer guidance for new prescriptions and to help physicians navigate prescriptions for patients who are already addicted.

Psychiatrists’ in-depth knowledge of addiction treatment can provide a level of support that primary care and emergency physicians might not otherwise receive. Many physicians do not have an expert to consult with when treating addiction. Telepsychiatry overcomes these obstacles and reduces the burden and potential harm caused by these disparities in support.