Paramedics and EMTs Need Better Addiction Training
Occasionally we have to call the paramedics because a client needs a higher level of care, sometimes because of detox and sometimes for other ailments. We have always found the Malibu teams to be efficient, dedicated and sensitive to the special needs of our clients, some of whom are “professional patients” (well versed in how to get emergency room doctors and urgent care doctors to give them narcotics).
So it came as a surprise to discover that not all local EMTs and paramedics are as well-trained about addiction as their Malibu colleagues. Last Sunday Sheila, one of our alumni and now resident of a sober living in nearby Ventura County, had a panic attack. She lost her balance, fell to the floor, and crashed into a coffee table. She ended up with a concussion. The sober living manager called 911. When the paramedics arrived, the owner made sure they knew she was an addict in early recovery (6 months of sobriety).
In the ambulance, the paramedics asked about her drug of choice. Meth she said – so they gave her morphine for the pain. I called the ambulance company and spoke with a paramedic who confirmed Sheila’s story. I asked why they had not first tried something less potent like Tylenol. I was told that morphine was the only pain killer they carry in the ambulance — and the paramedic had no idea that a meth addict could be triggered by injection of an opioid.
And then the same old story – it is important to keep the patient happy because the ambulance company would not want a bad review on Yelp.
I was stunned, and so was our entire clinical team. “Meth and morphine act on the same part of the brain, the region that creates craving behavior,” said Dr. Kenneth Blum PhD, our advisor on neuroscience. “The brain of an addict after just six months of not using drugs is still super sensitive. Introducing morphine can trigger an immediate relapse. It was the absolutely wrong thing to do.”
The only good news is that the paramedic I spoke with said that they were not opposed to being beter educated and enlightened about addiction.
The Affordable Care Act (commonly known as Obamacare) grants parity to mental health and substance abuse which means, according to the Office of National Drug Control Policy, that by 2020 the United States will need approximately 7,000 addiction medicine doctors to care for the estimated 27 million patients who are dependent on substances.
At the moment, most medical students are learning more about obstetrics – though after med school they will probably never deliver another baby — than about addiction evaluation, triage, intervention, detox, and treatment skills.
The University of Florida (“UF”) currently has the largest American Board of Addiction Medicine-Amerian Society of Addiction Medicine training program in the United States.
“Since I have been a Professor here at UF, we have trained over 50 Addiction Medicine Fellows for their Boards and many other professionals, ” said Dr. Mark Gold, the MD who is Chairman of the UF Department of Psychiatry. “We also train, every (I mean every) University of Florida College of Medicine student in classroom lectures. We hav e the only mandatory 2-week Clerkship rotation program. We were the first and still are the only Medical School that has elevated addiction medicine training to the level of Obstetrics or Surgery or Psychiatry. Interns must learn about the disease, do interventions, detox & treat patients, learn about AA, relapse and Recovery.”
The program is headed by Professor Scott Teitelbaum, M.D. a pediatrician who himself was trained in Addiction Medicine at UF.
I spoke with Mitchell Hall from the UF Department of Psychiatry’s Business Development about Sheila’s experience with the paramedics. He immediately said: “All first responders need the training. A specific course should be developed for fireman, EMTs, police. “
Here’s to the UF Medical School. We hope they create the course, offer it online, and that it becomes mandatory continuing education for paramedics and EMTs all over the country.
Photo: Dr. Mark Gold, MD