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Emergency Departments Can’t Ignore Addiction

Hospitals are legally responsible for providing effective care to people with substance use disorder.

Ambulance Driving on Road

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.

In a new legal analysis, the Legal Action Center (LAC) found that hospital emergency departments that do not follow the evidence to identify and treat patients with substance use disorders could violate a patient’s legal rights under four federal laws and risk legal consequences. Read the report.

Hospitals Must Help

What should hospital emergency departments do when people with substance use disorders come through their doors?

LAC’s report details three evidence-based practices.

Hospital Building

01 / Screening and Diagnostic Assessment

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.

02 / Medication for Opioid Use Disorder

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.

03 / A Facilitated Referral

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.

It's the Law

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.

Scales Weighing Healthcare

The Emergency Medical Treatment and Labor Act imposes an affirmative obligation on virtually every hospital to provide medical services to people who come to the emergency department with a substance use–related condition.

A hospital may be liable if:

  • The emergency department does not conduct a medical screening examination to identify a substance use disorder or performs a substance use disorder examination that is inconsistent with its procedures for screening ​and diagnosing patients with the same symptoms.
  • The emergency department identifies a substance use disorder-related emergency medical condition, but does not offer to administer buprenorphine — a medication used to treat opioid use disorder — as appropriate; and/or does not provide a facilitated referral to follow-up substance use disorder care and make naloxone available to reverse overdose, as appropriate.

The Americans with Disabilities Act (ADA) and the Rehabilitation Act (RA) prohibit hospitals from denying people health services because of their substance use disorder or use of drugs.

A hospital may be liable for “disparate treatment” discrimination if:

  • Its emergency department fails to offer evidence-based practices because of generalizations and stereotypes about people with substance use disorders, rather than a legitimate reason; and/or
  • Its emergency department’s “methods of administration” in treating substance use-related conditions have the effect or purpose of discriminating against individuals with substance use disorders.

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.”

Title VI of the Civil Rights Act prohibits hospitals from discriminating against patients with substance use disorders based on race.

A hospital may be liable if:

  • Its emergency department denies evidence-based practices for substance use disorder on the basis of race.
  • Denial of these emergency department services disproportionately impacts Black, Indigenous, and/or Latinx patients.

Lives Impacted

Hospital emergency department policies on treating substance use-related emergencies have real-life consequences for patients and providers.

Patient and a Doctor in a Hospital Room

“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.”

— Patient

“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.

Meet the experts behind the report.

Wall Collage and the LAC Logo

Sika Yeboah-Sampong

Staff Attorney
Legal Action Center

Ellen Weber

Vice President of Health Initiatives
Legal Action Center

Sally Friedman

Vice President of Legal Advocacy
Legal Action Center

For more information about this report's legal analysis

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