Hospitals are legally responsible for providing effective care to people with substance use disorder.
The addiction and overdose crises continue to escalate in the United States. The Centers for Disease Control and Prevention (CDC) reported in July 2021 that more than 92,000 people in the U.S. died from overdose in the year leading up to December 2020, an almost 30% increase over the previous 12-month period.
Further, Black, Indigenous, and Latinx individuals have seen some of the steepest increases in overdose rates nationally and, in some areas, the highest rates of drug and alcohol disorders.
Yet, many emergency departments discharge patients with substance use disorders without offering recommended and lifesaving care.
What should hospital emergency departments do when people with substance use disorders come through their doors?
LAC’s report details three evidence-based practices.
Emergency departments can use several validated screening tools to identify patients who should be examined for a substance use disorder using standard diagnostic criteria in the DSM-5.
While not all substance use disorders can be treated with medication, there are FDA-approved medications proven to help treat or avert opioid withdrawal, suppress opioid cravings and prevent opioid overdose. Buprenorphine, in particular, has been demonstrated to be administered effectively in the emergency department.
Making a “warm handoff” at discharge to connect patients to office-based care or an addiction treatment facility is a proven way to ensure patients have continued treatment and long-term help managing their substance use disorder. Making naloxone available, when appropriate, will prevent fatal overdose pending treatment.
How could hospitals be held liable if they do not use evidence-based practices to address a patient's substance use disorder in emergency departments?
LAC found four federal laws under which hospitals could be held liable.
A hospital may be liable if:
A hospital may be liable for “disparate treatment” discrimination if:
Additionally, a hospital is liable for failing to make a “reasonable modification” required by the ADA and RA if its emergency department does not provide these services upon patient request, and providing the services would not “fundamentally alter” the nature of the emergency department or constitute an “undue burden.”
A hospital may be liable if:
Hospital emergency department policies on treating substance use-related emergencies have real-life consequences for patients and providers.
“My son asked for help. We went to the emergency room, sat for 12 hours and were turned away because his [withdrawal symptoms] weren't bad enough … He deserved care regardless of how severe [emergency department staff] thought his withdrawal was. Today, he is dead.”
— Patient’s mother
“Hospital emergency departments do not know how to treat those who come in due to substance abuse. At best, their plan is to sober a person up and get them out the door. Happened to me more times than I can count.”
“The [emergency department] doctor was ... dismissive ... and classified my friend with ‘drug seeking behavior.’ He was offered no treatment, but was strapped to the bed for four hours and released with nothing but an overwhelming packet of papers.”
— Patient’s friend
EMERGENCY: Hospitals Can Violate Federal Law by Denying Necessary Care for Substance Use Disorders in Emergency Departments was produced by Legal Action Center — a nonprofit law and policy organization fighting discrimination against people with histories of addiction, HIV/AIDS and criminal records — with funding from the Bloomberg American Health Initiative.
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