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Emergency Departments, Substance Use Disorders, and Federal Laws

The following is a summary of the Legal Action Center’s new report: “EMERGENCY: Hospitals are Violating Federal Law by Denying Required Care for Substance Use Disorders in Emergency Departments.”

A report from the Legal Action Center (LAC) released this week shows hospitals could face legal repercussions for inadequately treating patients with substance use disorder (SUD). Just a day after the report, the American Society of Addiction Medicine (ASAM) released a training course for treating emergency department (ED) patients with opioid use disorder (OUD). Both have implications for EDs nationwide.

The LAC report, “EMERGENCY: Hospitals are Violating Federal Law by Denying Required Care for Substance Use Disorders in Emergency Departments,” discusses the hospital’s role in the battle against substance misuse and how emergency departments must conduct certain practices to not only comply with various federal laws, but also to potentially save lives.

The ASAM training is designed specifically for prescribers seeking to administer buprenorphine, which is commonly used to treat opioid dependence. As ASAM states, the “training module will provide essential education to empower prescribers in EDs to better identify, manage, and respond to patients with OUD.”

ASAM’s and LAC’s timing of their training module and report, respectively, is no coincidence. The United States is in the middle of a crippling SUD and overdose epidemic. According to the Centers for Disease Control and Prevention (CDC), 40% of U.S. adults reported struggling with mental health or substance use, and 13% of adults started or increased substance use to cope with COVID-19’s effects. The CDC also reported a record-breaking 93,000 overdose deaths in 2020.

While you are welcome to read LAC’s entire 65-page report, we wanted to provide a summary of the points most relevant to hospital administrators, ED directors, and emergency medicine physicians.

First, it is important to bring to light one major risk that hospitals face when treating patients with suspected SUDs. Hospital EDs could be liable for violations of the following federal acts: the Emergency Medical Treatment and Labor Act (EMTALA), the Americans with Disabilities Act (ADA), the Rehabilitation Act of 1973 (Rehabilitation Act), and the Civil Rights Act of 1964 (Title VI).

All four acts require specific care for patients with SUDs. EMTALA requires physicians to medically assess patients and identify life-threatening SUDs and then stabilize them. For those with moderate to severe substance use, physicians may need to administer opioid agonist medication in order to continue stabilization upon release. The LAC report also asserts that EDs must refer patients with potentially chronic, underlying issues to appropriate behavioral health treatment upon their discharge to comply with EMTALA. The ADA and Rehabilitation Act require physicians to treat patients based on objective assessments rather than stereotypes or myths. And Title VI prohibits physicians from discriminating, in any shape or form, based on race or color.

While the requirements and prohibitions of the various acts can be complex, there is a rather simple path to compliance, one supported by the U.S. Surgeon General and the National Institute on Drug Abuse: the implementation of three evidence-based practices:

  1. SUD screening and diagnosis based on proven methods
  2. Treating withdrawal and reducing cravings with opioid agonist medications
  3. Referring patients to the appropriate level of care upon discharge from the ED

For more information on these evidence-based practices, click here.

The key is for EDs to continue to treat the acute symptoms and stabilize patients diagnosed with SUDs, while also connecting them with the specialty inpatient or outpatient treatment they may need to combat a potentially chronic disorder. Following these three evidence-based practices will help ensure EDs accomplish just that, along with mitigating regulatory risks and increasing the likelihood of positive outcomes.

Inevitably, clinicians, researchers, and governments will continue to find ways to combat today’s mental health and SUD crises and improve treatment for individuals presenting with SUDs. Hospitals need to find ways to support their ED with the data, resources, and technology they need to use evidence-based practices today and be prepared for whatever comes tomorrow.

To read the full LAC report, click here.

Appriss Health can help hospitals integrate these best practices into a seamless workflow with our behavioral health care coordination solutions. Consumers can use the evidenced-based SUD Addiction Treatment Needs Assessment (ATNA) developed by Appriss Health, ASAM, and Shatterproof at treatmentconnection.com.

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