Immediate addiction treatment Pennsylvania

When Addiction Becomes an Emergency

Some of the most dangerous withdrawal syndromes include those from:

• Alcohol
• Benzodiazepines (like Xanax and Valium)
• Barbiturates (like Phenobarbital, Secobarbital, Amobarbital, etc.)

When a person is experiencing withdrawal from one of these substances it's important to seek emergency care at a hospital or detox center. If someone is in the throes of an alcohol withdrawal or other withdrawal syndrome without medical supervision, they can die.

Emergency treatment for alcohol and substance use disorders can involve a range of interventions, from medically supervised detoxification to emergency department care. These services are often provided at hospitals and other medical facilities where patients can receive immediate attention.

Overdose survivors are a priority population for immediate treatment following an overdose event, as well as a high-risk group that is at risk for frequent emergency department visits and hospital admissions.

SCAs shall coordinate with local hospitals and other emergency departments, including EMS personnel, to ensure that individuals who have overdosed or are identified in a hospital as needing treatment services are referred immediately into appropriate treatment services.

Emergency departments are often the first point of contact that people have with health and behavioral health systems.

Inpatient medical detoxification is one treatment for substance use disorders that requires hospitalization to manage acute physical manifestations of the addiction and co-occurring conditions and is typically provided on a 24-hour basis until withdrawal has subsided.

Signs of an Overdose

Some signs of opioid overdose may include:

• Unconsciousness
• Not being able to breathe
• Inability to wake up
• Choking sounds when trying to breathe
• Slow breathing and/or shallow breathing
• Skin that appears pale and/or clammy
• Hands or feet that are cold
• Bluish lips, fingernails, and/or skin

Opioid overdose signs include pinpoint pupils; pale or clammy skin; slow breathing or choking sounds; unconsciousness; and/or cold, blue fingers or lips.

Using Naloxone

Anyone can use naloxone by following the instructions that come with each kit. You do not need medical training to administer naloxone during an overdose. It is important to remember that naloxone does not replace emergency medical care; it should be used as a bridge until EMS arrives. The person who overdosed might not immediately wake up or feel better after receiving naloxone.

If you witness someone experiencing a possible opioid overdose, you should call 911 and give naloxone if you have it available.

Naloxone is safe for all ages. It can't hurt someone if they don't have opioids in their system and isn't harmful when given repeatedly.

Naloxone should be given anytime someone is not breathing, is unconscious, or you suspect that they have taken too many opioid medications. If the person does not respond after 2-3 minutes, give a second dose of naloxone.

You can purchase nasal spray naloxone prefilled devices over the counter without a prescription or you can get it at your pharmacy with the standing order written by Pennsylvania's Secretary of Health. You don't need to be a doctor, nurse, pharmacist, or other healthcare provider to use it.

Naloxone can be given to someone who is unconscious and has stopped breathing due to an overdose. Naloxone does not work when administered by mouth (swallowed).

Nasal spray naloxone comes in pre-filled devices that are easy to use. Each nasal spray contains enough naloxone for one dose. They can be administered by anyone who sees an overdose, even if they have never used the device before. Naloxone is safe and effective when used this way.

Pennsylvania's standing order lets anyone buy or receive naloxone without an individual prescription. However, you should still follow the instructions that come with your specific naloxone product.

Severe Withdrawal That Needs Emergency Care

Severe alcohol withdrawal can include tremors, seizures or delirium tremens (DTs). Severe symptoms are dangerous and may require emergency care.

In some cases, these symptoms can be life-threatening. If you experience any of the following severe withdrawal symptoms, seek emergency care:

• Seizures
• Delirium tremens (DTs), which is a severe form of alcohol withdrawal that causes confusion and visual and auditory hallucinations
• Fever
• Irregular heartbeats

Medical detoxification is necessary when patients are experiencing withdrawal symptoms that require medication intervention or management.

Withdrawal from alcohol and benzodiazepine can be life-threatening. It is important to be monitored while withdrawing from these substances and other substances for which medical detoxification is necessary.

You may need urgent medical attention if you are suffering from a severe withdrawal symptom, or have been diagnosed with delirium tremens. Signs of this condition include seizures, confusion, disorientation, visual hallucinations, fever and rapid heart rate. This condition can be fatal if not treated by emergency personnel.

Treatment Started in the Emergency Department

Emergency departments can start buprenorphine and refer to outpatient treatment. Buprenorphine should be given as soon as possible for a patient with an opioid use disorder who is actively experiencing opioid withdrawal symptoms. The emergency department is an ideal setting to initiate treatment because it provides access to patients that may not otherwise seek or find care on their own. ED physicians, nurse practitioners, and physician assistants can prescribe buprenorphine in the ED without special federal waivers.

Opioid withdrawal can be very uncomfortable, but it is not life threatening.

The ED physician is also providing ongoing treatment by prescribing buprenorphine for a period of time after the patient leaves the hospital. Buprenorphine can be dispensed from emergency departments or given directly in the ED.

Methadone is a long acting medication, prescribed only by special clinics that dispense it daily. Buprenorphine can be prescribed in the ED.

Buprenorphine can be prescribed to patients who present to the emergency department with active opioid use disorders. This could include people with opioid withdrawal symptoms or those who overdose and are saved with naloxone.

Warm Handoff to Treatment in Pennsylvania

A warm handoff moves overdose survivors quickly from an emergency department to substance use disorder treatment. A warm handoff ensures that overdose survivors can access care quickly and without delay, as many face significant challenges when trying to access care on their own. The goal of a warm handoff is to improve the continuity of care for an individual after an overdose has occurred and help them enter into treatment.

When a person presents to an emergency department or hospital after overdosing, their chances of receiving immediate addiction treatment is up to that particular hospital and county. The warm handoff to treatment can be performed by a certified recovery specialist, a substance use disorder provider, a case manager, or other staff at the emergency department who have received training on assessing and referring individuals to care.

A warm handoff moves overdose survivors from hospital emergency care to substance use disorder services, helping reduce the risk of a repeat overdose.

Overdose survivors may present themselves in various states of mind. When an individual has overdosed from opioids, they are likely to be unconscious or semi-conscious due to the depressant effect of opioids. Once they wake up, they may feel confused, disoriented, sick, or very uncomfortable due to withdrawal symptoms. They may also have cognitive impairment as a result of acute intoxication. In all cases, the individual is likely to have experienced severe physical stress that has left them feeling fatigued and emotionally vulnerable.

The warm handoff model provides individuals an opportunity for immediate follow-up care and support after an overdose event. This supports the continuum of care for individuals seeking recovery from substance use disorder by removing any barriers between emergency department treatment and subsequent referral to a treatment provider, case manager, or other service.

After the Emergency: Next Steps

After emergency care, ongoing treatment and recovery services are essential to help reduce overdose deaths. Opioid overdose prevention efforts should be paired with access to substance use disorder treatment to support sustained recovery and prevent future overdoses. Treatment can include medications for opioid use disorder (MOUD), such as buprenorphine and methadone, along with counseling or other behavioral therapies.

After emergency care, ongoing treatment services will help stabilize your health and give you support to recover from substance use disorder. You should contact a doctor or mental health provider to discuss your treatment options as soon as possible after being discharged from the hospital.

Treatment services for individuals with substance use disorders must be comprehensive, evidence-based, and individually tailored. Treatment services include withdrawal management, medically assisted detoxification, addiction treatment, recovery support, case management, medication-assisted treatment, and any other SUD service that is included in a client's individualized treatment plan. Treatment may occur in an outpatient or residential setting.

You may be offered case management if the facility you choose isn't able to offer the level of care needed right away. Case managers can connect individuals to services that address their specific needs, including treatment, recovery support, and medication-assisted treatment.

Substance use disorder treatment is available in Pennsylvania through a variety of outpatient and residential programs.

People who have overdosed need immediate treatment to survive and avoid permanent damage. Treatment for overdose survivors should be provided by a doctor or other health care provider and may include medication to reverse an overdose (Naloxone) or other medications as needed, depending on the substance(s) involved in the overdose.

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