Marshalltown native develops program to curb ER drug-seeking

The number of people who visited the emergency room for pharmaceutical drugs increased 98 percent between 2004 and 2009, according to the Center for Disease Control and Prevention.

Many of these visits were to fraudulently obtain prescription drugs, usually pain killers.

"Doctor shopping" is not an uncommon practice for those hooked on prescription drugs. The principle is simple: users go into the ER and claim to be in pain.

With policies in place to ensure patients who have pain management issues are not ignored, many doctors simply want to help someone suffering, so they prescribe the medications.

Hecticness is all too common in an ER, and the necessary conduit to get the patient's medical history is often sluggish.

Addicts take advantage all these things to get the fix they need.

A growing problem

Deaths from prescription drug use are now nearly on par with fatalities from car crashes, according to CDC reports.

Still, Vickie Lewis, director of Substance Abuse Treatment Unit of Central Iowa, said that alcohol is still, by far, the substance which poses biggest threat to public health.

While prescription drug use has certainly seen an steady increase over the last few years, she said, it isn't nearly the epidemic many make it out to be.

However, prescription drugs do seem to mirror alcohol insofar as the increase in their abuse likely stems from how readily available and socially acceptable they are, she said.

The level of distress and disfunction associated with prescription drugs is often just as devastating as other substances, Lewis said, and the risk they offer for dependency is no less real.

"When someone uses prescription drugs, and they use them over time ... it often takes medical intervention to get them clean," Lewis said.

Consistent Care Initiative

Marshalltown native Dr. Darin Neven saw a better way.

The problem, Neven said, is that because past legislation has conditioned doctors to be liberal with pain meds, there is often a lack of communication when it comes to prescribing.

And when drug addicts are rewarded for their subterfuge, they tend to repeat their behavior, Neven said, which puts a strain on hospital resources.

"Typically patients with very high ER visits, say 40 visits a year, have prescription pain problems," he said. "The prescription drug problem is really a byproduct of compassion."

ER doctors often can't get the information from primary care physicians in a timely manner to administer, or refrain from administering, prescription drugs, he said.

Neven began to see the strain the onslaught of repeated drug seekers put on ER staff, space and hospital budget where he works in Spokane, Wash. But his main concern was for his patients, not with "busting" addicts. He began to feel that the system was causing ER docs to cause more harm than good - going against their hypocratic oath.

"We are not against anyone getting pain medication properly," Neven said. "We don't want to be the policemen in the emergency department."

So he developed the Consistent Care Initiative.

Neven said the initiative's goal is to first not enable drug addicts, and second to help them get into a treatment program.

The initiative is an electronic system designed to work in the background of ERs, allowing doctors to keep pain management in the hands of the primary health care provider.

The best way for a doctor to treat a patient, is to do so regularly, Neven said. Administering pain meds is not the role of an ER doctor.

"It's basically a lesson plan for the substitute teacher, which is the ER doc," he said.

The Consistent Care Initiative came about because all four hospitals in the Spokane area were connected by one computer system, which allowed the hospitals to hook into the Emergency Department Information Exchange. Then, the system automatically faxes over patient information and puts it on their chart with no extra work for doctors and nurses.

EDIE is then able to flag repeated drug seekers. To date, EDIE has identified 633 repeat offenders.

The program is now in 19 hospitals across Washington, and Neven is looking into a CDC-funded project that would evaluate the effectiveness of putting the system in place in all 91 hospitals in Washington. He is pursuing a grant from the Attorney General's Office obtained in a pharmaceutical settlement, he said.

Local methods

Director of ER Services and ICU at MMSC, Theresa Hiller, said although the hospital doesn't have the Consistent Care Initiative, the spirit is the same.

"Without the formal program, we all already do that without the title and frill," said Mary Schreurs, chief nursing officer at MMSC.

Meaning, that in a community the size of Marshalltown, managing patients in the ER is less hectic. MMSC staff are in the habit of always checking with the primary care physician regarding a pain management regiment, she said.

Communities such as Marshalltown differ greatly from metropolitan areas like Spokane, Schreurs said. Drug-seeking behavior isn't much a problem, as the ER at MMSC doesn't manage chronic pain problems.

"It's detrimental to the ER system to have doctors and nurses coming in with preconceived notions about patients," said Liz Zuercher, business development and communications executive at MMSC.

Treating patients in the ER is such an individualized process, Hillers said, that commenting on any trends is difficult.

MMSC staff does its best to set up patients that come into the ER without primary care providers with doctors who can take care of their needs long term, Zuercher said.

"Care coordination is what it's all about," she said. "The right hand knows what the left hand is doing."

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Contact David Alexander at 641-753-6611 or dalexander@timesrepublican.com

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Marshalltown native develops program to curb ER drug-seeking