Emergency Departments Unite to Combat Epidemic of Opioid Over-Prescribing and Avoidable Death

Press Release:

The Los Angeles County Prescription Drug Abuse Medical Task Force, a collaborative effort representing physician and nursing groups, hospital associations, and public health and community clinic representatives, announced today that emergency departments (EDs) across Los Angeles County are implementing standardized clinical guidelines for the safe prescribing of opioid pain medications to combat a national epidemic of opioid over-prescribing, misuse, overdose, and death, and to mitigate doctor and ED shopping for prescription pain medications.

“According to the CDC, there is a national epidemic of prescription opioid abuse that takes about 16,000 lives each year in the U.S.”

Seventy-five (75) hospital emergency departments throughout Los Angeles County serving adults, including Los Angeles County public hospitals, Kaiser Permanente, Providence Health & Services, UCLA Health, Dignity Health, Daughters of Charity Hospitals, and other hospital EDs, including those served by Emergent Medical Associates (EMA), are rolling out standardized treatment and opioid prescribing practices, derived from the American Academy of Emergency Medicine (AAEM) guidelines and adopted by the California Chapter of the American College of Emergency Physicians (Cal-ACEP). This initiative across Los Angeles County follows in the footsteps of a similar effort in San Diego and Imperial Counties.

“According to the CDC, there is a national epidemic of prescription opioid abuse that takes about 16,000 lives each year in the U.S.,” said Jeffrey D. Gunzenhauser, MD, MPH, interim health officer, Los Angeles County Department of Public Health. “And we know that in Los Angeles County in 2013, there were nearly 400 lives lost due to prescription opioid overuse. Nationally, deaths from prescription opioids are greater than those from motor vehicle accidents each year, and greater than deaths from heroin, cocaine, and benzodiazepine drugs combined each year.”

“We also believe that these new safe prescribing guidelines will ensure that patients are prescribed appropriate medications by their physicians and will also reinforce standardized opioid prescribing practices in all emergency departments. The goal is to avoid high risk opioid over-prescribing and to mitigate opioid pain medication overuse, overdose, diversion, and doctor and ED shopping,” noted Maureen McCollough, MD, Los Angeles County Department of Health Services, Olive View-UCLA Medical Center, Emergency Medicine, and member of the California Chapter, American College of Emergency Physicians (Cal-ACEP), which is sponsoring this initiative statewide.

Some of the prescribing practices in the guidelines include:

  • Use opioid medications as a last resort and only for severe non-cancer pain at the lowest possible doses
  • Avoiding intravenous or injectable opioids in patients who are already taking chronic (long-term) opioid medications
  • ED physicians will not replace so-called “lost” or “stolen” opioid prescriptions
  • ED physicians will only prescribe a limited days’ supply, such as three days, for oral opioid pain medications
  • Promote one prescriber and one pharmacy for pain medication treatment
  • Use the State of California CURES database

“Long-term daily opioid use of 90 days or more is no longer considered good clinical practice for non-cancer pain,” said Joel Hyatt, MD, emeritus assistant regional medical director for Kaiser Permanente Southern California Region. “Recent clinical evidence supports use of opioids for short-term moderate to severe pain. These clinical guidelines directly address the over-prescribing of high risk prescription opioids, misuse, and diversion, e.g., prescriptions left in medicine cabinets that are commonly used or sold by family or friends, including children.”

Kaiser Permanente provided a community benefit grant to fund printing and distribution of an initial two months’ supply of patient information handouts for the 75 EDs across Los Angeles County, i.e., more than 386,000 handouts to be used to educate and inform patients and consumers at discharge after ED visits.

The Los Angeles County Prescription Drug Abuse Medical Task Force includes the Los Angeles County Departments of Public Health and Health Services, Cal-ACEP, the Hospital Association of Southern California, Kaiser Permanente, the Los Angeles County Medical Association (LACMA), the California Emergency Nurses Association (CENA), the Community Clinic Association of LA County (CCALAC), and the San Diego Prescription Drug Abuse Task Force.

“This task force is uniting with physicians and emergency department staff, providing them the tools and guidelines that will help them communicate these practices to all patients and consumers. These are prescribing practices that can save lives, and spare families the heartache of losing their loved ones,” said Pedram Salimpour, MD, President of the Los Angeles County Medical Association. “When patients turn to the ED for pain management, the task force guidelines, applied consistently, can be part of the solution to combat opioid medication overuse, abuse, and doctor shopping.”

For more information on the work of the Task Force, go to: http://www.lacmanet.org/advocacy/safe-prescribing.aspx.

About Kaiser Permanente Southern California

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve more than 3.8 million members in Southern California. Care for members and patients is focused on their total health and guided by their personal physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. For more information follow us on Twitter: @KPSCALNews, or go to: www.kp.org/share.

About Los Angeles County Department of Public Health

The Department of Public Health is committed to protecting and improving the health of the nearly 10 million residents of Los Angeles County. Through a variety of programs, community partnerships, and services, Public Health oversees environmental health, disease control, and community and family health. Public Health comprises nearly 4,000 employees and has an annual budget exceeding $900 million. To learn more about Public Health and the work we do please visit http://www.publichealth.lacounty.gov, visit our YouTube channel at http://www.youtube.com/lapublichealth, find us on Facebook at http://www.facebook.com/lapublichealth, or follow us on Twitter: @LAPublicHealth.


County of Los Angeles Department of Public Health
Natalie Jimenez, (213) 240-8144
Kaiser Permanente Southern California
Socorro Serrano, (626) 405-3004

Emergency Physician hospitalized after alleged attack

From the News:

A Grosse Pointe Woods doctor drove himself to a Warren hospital Friday after he said he was stabbed with knives and syringes, according to police.

Warren officers responded around 6:25 a.m. Friday to St. John Macomb Hospital where the man was seeking treatment, Sgt. Stephen Mills said.

“It was determined he was the victim of a crime, that he was stabbed in Grosse Pointe Woods,” Mills said.

The hospital confirmed an emergency room doctor by the same name was in fair condition early Friday afternoon. He has been employed at the hospital for about a year, said Brian Taylor, a hospital spokesman.

‘Doc fix’ bill would overhaul health IT policy, support telehealth

From Modern Healthcare: (hat tip: Dr. Menadue)

The bill introduced Thursday to replace Medicare’s sustainable growth-rate formula for physician pay would also significantly alter federal policy on health information technology.

The bill would also reward remote patient-monitoring and telehealth as clinical practice improvement activities. “Those are all good things,” said Joel White, the head of Health IT Now, which describes itself as a coalition of patient groups, provider organizations, employers and payers.

They’re Called ‘Critical Access Hospitals’ for a Reason

From HealthLeaders Media:

Unfortunately, some people in Washington, DC have short institutional memories.

For the past couple of years, reports from the Office of the Inspector General at the Department of Health and Human Services have made it clear that they believe the CAH designation and funding scheme should be overhauled.

In its latest shot across the bow, OIG this week called for a re-examination of the swing bed program that allows CAHs to provide long-term care. The OIG audit claimed that the federal government has overpaid CAHs $4.1 billion over the past six years for services that could have cost less in relatively nearby skilled nursing and long-term care facilities.

Mayo Clinic researchers discuss use of drones in healthcare

From Becker’s:

Three researchers from Rochester, Minn.-based Mayo Clinic’s surgery department are discussing the idea of using drones to deliver medical materials to clinics, disaster areas and remote locations.

The drones could overcome the difficulty of getting sensitive materials, such as blood samples, to remote areas that are arduous to reach by car. Drones have successfully delivered materials for aid workers after the Haitian earthquake in 2012 and transported dummy TB test samples in Papua New Guinea for Doctors Without Borders. Transporting perishable materials in areas and times of critical need is often costly and slow, and the use of drones — vetted for safety and efficiency — could improve healthcare organizations’ ability to get critical supplies to rural clinics and disaster areas, according to an article the three researchers published in the Air Medical Journal.

A New Blood Test Could Stop Doctors From Overprescribing Antibiotics

From Time:

Scientists claim to have established a new blood test that can help doctors quickly distinguish between bacterial and viral infections, giving physicians the ability to prescribe antibiotics more accurately. That’s according to a study published by PLOS One on Wednesday.

Israeli-based company MeMed, along with researchers from other institutes, says that they examined over 1,000 patients and found that their ImmunoXpert blood test could distinguish between immune responses to bacterial or viral infections. The procedure is reportedly fast, taking only hours to complete when alternatives often require days.

VeinViewer, A Medical System That Projects an Image of Veins on Skin to Help Clinicians Insert an IV

From Laughing Squid:


VeinViewer is a medical system designed by Memphis-based company Christie Medical Holdings that uses near-infrared light to create a high-definition image of a patient’s vein, which is then projected in real-time onto their skin to help clinicians insert an IV without incident.

The Tricorder, An All-In-One Diagnostic Device, Draws Nigh

From ReadWrite:

After pushing back deadlines by a few months, the 10 remaining teams in the Tricorder X Prize are nearing the day they will deliver a device that can diagnose 15 diseases and other basic health information through at-home tests. The teams are scheduled to deliver working prototypes in June to a UC-San Diego study that will test the devices on patients with known medical disorders to measure their accuracy.

How Physicians Care for Patients in the Most Isolated Place on Earth

From Mental Floss:

In Antarctica, the coldest and most isolated place on the planet, even the simple act of breathing becomes an endurance test. Home to three permanent U.S. expedition outposts—McMurdo Station, Amundsen-Scott South Pole Station, and Palmer Station—it’s inaccessible eight months out of the year due to oppressive weather conditions. Researchers from a variety of countries fly in with the knowledge they’re about to be effectively cut off from the world.

But what happens when a medical situation arises? More than 2800 miles from the nearest hospital in New Zealand, Antarctic crews must rely on the expertise of a single physician responsible for upwards of 150 people. (The number varies by season.) Working autonomously, the doctor is charged with analyzing x-rays and blood work, providing aftercare, overseeing pharmaceutical duties and even performing dentistry. Serious conditions that could be managed in a major facility become radical emergencies. Surgery is a major undertaking, and intensive care can’t be sustained.

Such adversity is not for the claustrophobic or easily shaken. But for Mole, volunteering was academic. “I signed up,” he says, “because I wanted the challenge of providing medical care in the most remote and austere environment on Earth.”