[This post provides a followup to the chapter "Addicts in the ED" in my book "Game-Changer: Game Theory and the Art of Transforming Strategic Situations".]
In “Game-Changer” (published Jan 2014), I discuss the problem of rampant opioid misuse and abuse from a game-theory point of view. At the end of the chapter, I predicted the future direction of the strategic ecosystem around opioid prescriptions in the Emergency Department, that hospitals would enter a “race to toughness,” adopting new strategies to make it more difficult for drug-seekers to get opioids in their own facilities, without addressing the underlying problem of opioid dependence.
This is now happening. Earlier this week, NPR reported on the rise of programs to deny narcotic painkillers (opioids) to patients who are found to be abusing the system. See “Emergency Rooms Crack Down On Abusers Of Pain Pills.”
Such programs help hospitals by reducing the burden of serving drug-seekers (freeing up resources to serve other patients) but also improve the bottom line as drug-seekers are not profitable patients from the hospital’s point of view: “Because many of these narcotics-seekers lacked insurance, eliminating their repeat ER visits saved [San Juan Regional Medical Center in Farmington, New Mexico] about half a million dollars a year, enough to pay for about six full-time nurses in the emergency department.”
Unfortunately, such policies do little to address the fundamental problem of opioid misuse and abuse. Much better would be to adopt best-practice policies, such as those spearheaded by Yale’s Gail D’Onofrio, to steer opioid-seeking patients toward programs that can help them control of their pain and their drug dependency. I’m grateful to Dr. D’Onofrio for the help she provided when I was researching how to change the game of opioid misuse back in 2012.
It’s about time that her ideas received the wider embrace that they deserve. See “Why Not Start Addiction Treatment Right In The ER?”.