By Julie Doniere, MD
WACEP Board of Directors

There is a dark, smelly staircase leading from the parking garage into my Emergency Department.   Five years ago when I climbed those stairs at the beginning of my shifts, I distinctly recall feeling like I was walking down to the gallows.  In retrospect, I was completely burnt out and I now recognize that one of the things sucking the life out of my soul was the constant head-butting with my patients over opiate prescriptions.  

Admittedly, I still don't ascend those steps on the wings of doves; however, after becoming more involved and educated about the opiate epidemic my work-related stress has substantially subsided. 

It is important for us to realize that emergency physicians did not cause the opiate crisis!  New research led by the Mayo Clinic shows opioid prescriptions from the ED are written for a shorter duration and smaller dosage than those written elsewhere.  Similarly, a study recently published in the Annals of Emergency Medicine, also demonstrates that patients who receive an opioid prescription in the ED are less likely to progress to long-term use. We may not be the cause of the problem, but we sure have to deal with its outcome every shift at work. We are fortunate to be practicing in Wisconsin at this time, as our state has been particularly proactive in this arena.

Changes that Wisconsin has implemented over the past few years have been impressive.  State Representative John Nygren put together a forward thinking and very effective initiative on opioid prescriptions, the EPDMP has been a useful tool for all ED physicians, and the number of prescriptions for opiates has fallen across the State. WACEP has, of course, been an active presence throughout this journey. Milestones include publishing statewide best practices and information handouts for opiate prescribing in the ED, providing original EM-specific CME to comply with the mandatory opiate education requirements, and having emergency physician and WACEP member Tim Westlake honored by the Wisconsin Medical Society as a physician citizen of the year for his dedicated efforts in combatting the opioid epidemic.

Most recently, I attended the October meeting of the Wisconsin Coalition for Opiate Prescription Reduction on WACEP’s behalf. At the meeting, key stakeholders highlighted steps that our state has taken in the opiate crisis and outlined a vision for the future.  As mentioned earlier, it has been shown that the ED has not been the prevalent source of narcotic prescriptions.  OB, Neurology, and Primary Care were well represented at this meeting.  They, too, have curtailed their prescriptions greatly.  That is encouraging news of course; however, as it has become more difficult and costly to attain prescription narcotics, there has been a dramatic rise in heroin abuse.  It is heartening that the Wisconsin state legislature is directing its focus towards the treatment of that abuse and that funding for treatment centers is increasing.  WACEP will continue to negotiate to ensure equal access to those in need across our state.

So, continue to fight the good fight.  Please know that WACEP will continue to work with the legislature to increase funding and access to treatment of opiate abuse.