The way patients in the Transgender Surgery Center are cared for at Mount Sinai Beth Israel in New York City has led to some innovative revelations to help end the nation’s opioid epidemic.
“Gender affirmation surgery is a significant and invasive surgery and the last thing we want is to treat the gender dysphoria but have the patient end up physically dependent on opioid analgesics post-surgery,” said Erick Eiting, MD, Vice Chair of Operations for Emergency Medicine at Mount Sinai Downtown.
Similar to other surgical settings, Dr. Eiting and his colleagues work to limit the amount of prescriptions administered during a patient’s hospital stay through non-opioid pain management strategies. These efforts continue post-operatively to address the potential risk of chronic pain and subsequently the risk of developing an OUD.
While Dr. Eiting says they still are collecting data, the outcomes appear positive.
“We saw that this was working for our transgender patients and thought why not expand this more broadly to see if these clinical pathways would help other surgical patients?”
In addition to the work of reducing opioid exposure, Dr. Eiting also explained efforts to overcome other barriers faced by the LGTBQ community.
Many of the LGBTQ patients that Dr. Eiting sees have experienced housing instability, for example.
“Many of my patients are estranged from their families and have lived or are living on the street, they’re uninsured or underinsured, and so finding treatment options that work for them is a complicated equation,” he said. “We have to find the right destination where patients can actually get access to treatment—the same treatments exist for everyone in theory, but often my patients can’t do 28-day programs without risking loss of employment and if they end up on a six-month waiting list for a program, that means going untreated for that time which can be a death sentence.”
Dr. Eiting, an emergency medicine physician, also highlighted the increase in the number of physicians in the emergency department now trained to start a patient on buprenorphine—and that half of the physicians now have a DATA-2000 waiver.
“There’s a lot of institutional policy in place before anyone writes a prescription for opioids, but the stigma still exists. There is a judgment about SUD being a moral failing that we need to overcome, and how we get there is having everyone trained to understand that addiction is a medical condition for which there is substantial treatment.”
Part of that treatment also includes having all patients entering the ED screened for a potential SUD, distributing naloxone and starting a universal hepatitis C monitoring program last June which helped them to discover that about 30% of patients who test positive for Hepatitis C do not identify any markers “These people usually have an undiagnosed opioid use disorder and so we have revaluated how we handle that.”
Ultimately the success of programs like the ones being run out of the emergency department at Mount Sinai are about having a multi-pronged approach and understanding that everyone who walks in your door is coming from different circumstances and require a plan of treatment that acknowledges that. “This applies to LGTBQ patients, African American and Hispanic communities, Asian communities and all others in our community. “We try to do everything we can think of to meet patients where they are at.”
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