TUH doctors: Legislation could overcrowd rehab beds

An amendment introduced by a state representative would add drug overdoses as a medical health reason for commitment.

Dr. Camille Paglia, the medical director of the Crisis Response Center at Temple University Hospital’s Episcopal branch, said she would feel lucky if she could treat half of the people at TUH who fill the waiting rooms who are seeking rehabilitation from drug addiction.

“I can tell you that the hardest part of the whole process is that there are not nearly enough beds for all the people who want detox or rehabilitation,” she added. “It’s the hottest bed in the city.”

TUH officials said they are concerned with state Rep. Matthew Baker’s proposed amendment to the state’s Mental Health Procedures Act, which would add drug overdoses as a reason for involuntary commitment, which allows hospitals to admit people to a mental health unit without their consent.

Doctors said the act would overcrowd the limited bed space for detox.

TUH is in the North Planning District, serving residents from Hunting Park, Kensington, Feltonville and other neighborhoods.  The district was defined by the City’s Department of Public Health as part of the 2016 Community Health Assessment. According to the assessment, the North Planning District had 30.1 opioid-related deaths per 100,000 people, making it the district with the third-highest rate of opioid-related deaths in 2015.

The amount of unintentional, opioid-related overdoses surged in 2015, with nearly 700 deaths — twice as many deaths by homicide, according to the Philadelphia Department of Health.

Dr. Joseph D’Orazio, a professor of emergency medicine physician at the Lewis Katz School of Medicine and member of Mayor Jim Kenney’s opioid task force, said TUH is at the center of treating the opioid epidemic.

“Now, [the state] is going to add on this act that we’re going to involuntarily commit people for rehabilitation, but if there are no beds available, where do we put those people? How do we care for those people we are committing?” D’Orazio said.

“Do we have enough treatment beds? Probably not,” Baker told The Temple News. “However, we need to start somewhere to try to save these people’s lives and get help for them.”

Baker said that people dependent on drugs cannot acknowledge that they need treatment, and they are immediately released without any more treatment after the overdose.

In January, Pennsylvania Gov. Tom Wolf requested $10 million from the state legislature to supply emergency responders with naloxone, also known as Narcan, a life-saving drug used to treat overdoses in emergency situations.

“We offer the patients treatment, but the reality is most patients will come to the emergency department after they received Narcan,” D’Orazio said. “Immediately, or shortly thereafter, they leave and do not even get all their medical care.”

Paglia is unsure if involuntary commitment is effective in combatting substance abuse.

“I have seen patients whose family pressured them into treatment, and they kind of reluctantly come here,” she said. “They almost always ask to leave within an hour or two. The time involved to get somebody into a detox can take hours. Somebody who really doesn’t want treatment is not able to tolerate that.”

Baker said the amendment will address the concerns from loved ones to a person dependent on drugs who want to see involuntary treatment for their sibling, child or spouse.

“Families and loved ones, who I have been hearing from all over the state, want help for some of these people,” Baker added.

Paglia said that an alternative to this amendment would be to license more facilities to treat drug addiction. D’Orazio said he believes there are other ways of stopping the opioid epidemic, like limiting the amount of opioid prescriptions written by doctors.

“We need to act just the same way we did for Ebola for this opioid epidemic,” D’Orazio said. “There is a stigma that goes along with a drug-addiction diagnosis, but opioid-use disorder is a disease, just like an infectious disease or chronic medical diseases.”

“We’ve got a serious problem in this country and we need to take a look at whatever tools we can to save some lives and get help,” Baker said.

The bill is in the process of seeking co-sponsorship from another state representative. Baker said that he has not yet faced any opposition to his amendment from anyone else in state legislature, the medical community or constituents.

Kelly Brennan can be reached at kelly.brennan@temple.edu or on Twitter @_kellybrennan.

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