New Hampshire Study Looks at Emergency Room Personnel Attitudes Toward Opioid Crisis

ER nurse with patient
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The opioid crisis dominates the attention of medical and mental health providers who work in substance use disorder treatment. While addiction – which we now call the disordered use of substances or alcohol, as in substance use disorder (SUD), opioid use disorder (OUD), and alcohol use disorder (AUD) – to substances other than opioids remains a persistent public health problem in the U.S., the opioid overdose and addiction situation is more than a problem.

It’s a very real crisis. Opioid overdose has claimed the lives of over half a million people since 1999, and over a million people have died of drug overdose overall since 1999.

That’s why we write and publish articles on the opioid crisis on a regular basis. We want individuals, families, and communities to know we know what they’re going through, we know the harm and heartache they experience, and we know how to help them.

To learn more about the opioid crisis and how addiction treatment providers work to help address the ongoing situation, please read these two articles on the blog section of our website:

The Opioid Crisis: Treating Opioid Use Disorder (OUD) in West Virginia

Experts Predict New Wave of Opioid Overdose Fatalities

Opioid Crisis Report: Potential Fentanyl Vaccine Makes Headlines

Most of our articles contain the latest data on the opioid crisis. We present and discuss topics like medication-assisted treatment (MAT), harm reduction strategies, effective new – and old – approaches to treatment, and any promising developments of any kind related to opioid use disorder (OUD) and treatment for opioid use disorder (OUD).

We focus primarily on two things: the patient/family experience and the treatment provider perspective/experience.

This article addresses an equally important group of people directly involved in the opioid crisis: emergency personnel who interact with overdose victims and people with OUD in an emergency room setting.

The Opioid Crisis: The Role of the Hospital Emergency Room

A hospital emergency room is a place where we see all sides of the human experience. People arrive injured or sick. Some seek help for serious but simple injuries, like a broken bone. Others arrive after car accidents, while others visit the ER for help with unknown problems or conditions: that’s why they’re there – they want to find out what’s wrong. Still others arrive in the ER after a life-threatening opioid overdose.

Some overdose victims die in the ER, while others survive with the help of ER personnel and the lifesaving overdose reversing medication, Narcan.

In all cases – injuries, accidents, or overdose – the professionals whose work takes them to the emergency room –  rom physicians and nurses to firefighters and police officers to social workers and hospital staff – spring into action to help save lives and serve people in need.

While substance use disorder (SUD) treatment providers like us here at kathyireland Recovery Centers work on the front lines of the opioid crisis, it’s fair to say that ER personnel may be even closer to the front lines than we are.

They see pain and heartbreak up close, every day, in a way that we don’t. They’re often the first line response to overdose, and they often help people with OUD get treatment for the first time, ever. In fact, some people who overdose have no idea treatment and support is an option until it’s suggested by a paramedic, a police officer, or an ER physician or nurse.

Therefore, they’re a critical component in the treatment continuum.

And like the front-line hospital workers we celebrated in New York City but fade from our memory over time, it’s easy to forget that these emergency workers see the effects of the opioid crisis every day of the year.

Emergency Room Personnel: What’s Their Perspective?

In this article, we’ll discuss a recent study where ER workers – and their attitudes – are not forgotten, but rather the entire focus of the research. This study is important because ER personnel are often the first contact a person with OUD has with any medical support whatsoever, and often the first time they learn about the various treatment options available to them.

That means that what ER workers say and do can have a significant impact on what happens after the ER visit. Their behavior can play a role in whether a person returns to life – and addiction – as usual, accepts treatment right then and there, or listens, learns, and seeks treatment somewhere else after they leave the emergency room.

In order to explore the various attitudes emergency room personnel espouse, a group of researchers conducted a study and published the results in a paper called “Compassion, Stigma, And Professionalism Among Emergency Personnel Responding to The Opioid Crisis: An Exploratory Study In New Hampshire, USA.”

In the study, researchers recruited a total of 36 professionals whose work brings them into contact with hospital emergency rooms and opioid overdose victims. The participants work as emergency and/or medical personnel in five New Hampshire counties: Cheshire, Grafton, Hillsborough, Rockingham, Strafford, and Sullivan.

Here’s a breakdown of their job titles, and the number of participants by job title:

  • Administrators or physicians in ER leadership positions: 7
  • Typical ER physicians: 4
  • ER nurses: 5
  • Paramedics: 1
  • Physician’s assistants: 1
  • Emergency Medical Technicians (EMTs): 6
  • Firefighters: 6
  • Police officers: 6

Participants were “interviewed about their experiences responding to overdoses and their perspectives on individuals who use opioids.” Researchers then analyzed the content of each interview to identify common themes in their responses, then categorized them by their underlying similarities.

Let’s look at what they found.

Human Reactions: Compassion, Stigma, and Mixed Feelings

The opioid crisis is a human problem. Therefore, it’s no surprise that the responses of the humans in the ER room did not fit easily into a box, or a series of easy-to-define boxes. Instead, the responses varied. And in some cases, attitudes were not clearly defined, but opposing. Individual workers often expressed both compassion and frustration, depending on the both their personal circumstances and their direct experience with patients in the ER for opioid use or opioid overdose.

With that said, researchers created six basis categories of response. We’ll list each of these categories now, along with representative responses from each category.

Category 1: Various Degrees of Compassion and Stigma

ER workers in the same department often held differing perspectives, as we demonstrate here.

  • Compassionate response: “They’re human. They’re our patients. They have a problem. They’re not abusing the system. They have a problem. We get paid to fix the problem.”
  • Objective response: “I’m not here to judge people. I’m just here to do my job. People have different types of problems, and I think…it’s just another disease.”
  • Stigmatizing response: “I get the people that are on pills…from injuries or whatever and transition to heroin. Obviously, I can see that. With the person that just decides to do heroin because they’ve done marijuana, they’ve done cocaine, and now they’re going to progress to heroin – you’re an absolute idiot.”
  • Conflicted response: “My personal feeling is that I feel like we do a lot…we really push ourselves to help these people…I’ve personally sat down and had heart-to-hearts with these people, knowing inside that they’re probably not listening to me. It’s an absolutely horrible disease…But you’re still making conscious choices. You’re still making conscious decisions to use.”

Category 2: Attitudes Changed Over Time

Many ER workers report that their perspective changed, based on their experience working directly with people who use opioids or overdosed on an opioid.

  • Became more compassionate: “If anything, I’ve become more understanding because I’ve seen the addiction in more people now. I have even more belief in the fact that I’m there to help them get the help they need.”
  • Became less compassionate: “You get frustrated with people that you see time and again, and you don’t really feel as much compassion. It’s a little bit harder to muster sometimes, I think, just from the sheer number of times that you see them, and you just want to see them get better, and they’re not.”
  • Developed more conflicting feelings: “I struggle with this internally, I think. I don’t know how much sympathy I have in the end, but I still try to empathize with them.”

Category 3: Views Common to a Compassionate Perspective

Participants with a compassionate perspective most often had a personal connection – family or otherwise – with an individual or individuals who used opioids.

  • In response to one overdose call, a police officer stated “I went to an overdose this past year where I had to wake up the guy’s kid, who is the same age as my own, and tell him that his dad was dead, and then had to usher him out of the house so that he didn’t see his dead father laying on the floor. That resonates with me.”
  • An ER physician made this statement about the death of a co-workers child from opioid overdose: “In his honor, I am trying to give back.”
  • An EMT who works on an ambulance said: “Part of our standard protocol is to ensure that we’ve explained to them the benefits of accepting care and transport to the hospital and the potential risks if they refuse… If we’re trying to convince someone to go to the hospital, we use whatever resources are available to us.”

Category 4: Views Common to Conflicted or Stigmatizing Perspectives

  • Conflicting perspective: “I think that people are under the misunderstanding sometimes that if you come into the emergency room that we’re going to be able to help you all the way through it and we just can’t. That’s not our job. Our job is to stabilize and treat the immediate injury.”
  • Stigmatizing perspective: “I think a lot of patients come to the emergency department thinking that we can solve all their problems. They come to the hospital assuming that we have the resources to do this. They’re looking for help, and I don’t have any to give them”

Category 5: Compassion Despite Conflicting Personal Opinions

ER personnel in this category also derived compassion from personal connection, similar to personnel who were compassionate by default.

  • Compassionate perspective from a police officer who is typically biased toward people who use opioids: “There’s a 16-year-old that I used to coach in football. He uses drugs now. He doesn’t call me Officer. He calls me Coach still to this day. It absolutely breaks my heart.”

ER personnel also displayed compassion about treatment when they saw successful treatment outcomes.

  • Compassion based on observation: “I can recall a patient who overdosed repeatedly. She has been sober for a year and her life isn’t dictated by opioids. I wish we heard more about that. It really is nice to actually have someone who still is in that community who actually turned it around.”

Category 6: Professional Responsibility Overrides Personal Bias/Opinion

Over half of the ER medical personnel took the point of view that their professional role meant their personal opinion had no bearing on the way they viewed or treated their patients.

  • Professional perspective: “I’m a medical professional. My job is to fix them medically. It’s not my job to judge why or if or when. Who knows? Maybe the eighth time is the one where he finally figures it out, and that’s our job to continue to do that.”

As we mention above, the opioid crisis is a human crisis, and the people who meet the crisis at the emergency room level are all human. That means each person who works in the ER has a unique perspective based on their personal and professional experience, which are reflected in the answers we share above.

An Expert Opinion on This Study

It’s important to note that another article was published alongside this study: an editorial called “Editorial: Responding In Crisis: Experiences Of Compassion, Stigma, And Professionalism Among Emergency Personnel During The Opioid Epidemic,” co-written by two medical professionals who reviewed all the source material associated with the initial publication.

They summarize the findings in the study in a clear and concise manner, defining the various responses as either a. compassionate, b. stigmatizing, or c. professional. Compassion derives from personal connection, stigma derives from personal bias, and professionalism derives from a sense of personal ethics.

In their view, the most significant takeaway from the ER personnel was that – regardless of their initial attitudes and assumptions – when an ER professional witnessed a successful recovery story or had a personal connection with a person who uses opioids, their bias and stigma transformed to understanding and compassion.

That resonates with us.

We can do our part to share examples of people who choose treatment, engage successfully, and turn their lives around. That can inspire the people in need of support. It can also encourage the professionals who work in an emergency room setting to set aside their preconceived notions and open themselves to the idea that people with OUD are simply people who have a medical condition from which they can recover with the appropriate treatment.