Drug treatment can start in isle emergency rooms

FOR anyone who has spent time in the waiting room of a hospital emergency room, it comes as little surprise that as many as 40 percent of patients treated are under the influence of alcohol or illicit drugs at the time of treatment. What's surprising -- and disturbing -- is what happens to these patients.

Far too few of these patients are ever screened and treated for alcohol and drug problems, even in the face of evidence that such efforts are both effective and cost-efficient. As a result, many of these individuals continue to abuse alcohol and drugs and end up back in the emergency room.

One of the strategies identified in the Hawaii Drug Control Plan, released in January 2005 by the Lingle-Aiona administration, is to provide a continuum of treatment options.

"Screening, Brief Intervention, Referral and Treatment," or SBIRT, is a program derived from the understanding that significant steps can be taken in a hospital emergency room to address the problems of abuse, dependence or addiction. Hospital emergency rooms are particularly useful SBIRT sites because, having just experienced the ill effects of their drinking or drug problems, patients tend to be more vulnerable and open to intervention and dialogue. It is at this "teachable moment" that individuals can especially benefit from screening, education, counseling and, if necessary, referral to treatment.

DRINKERS WHO receive SBIRT have been shown to have 48 percent fewer readmissions to the hospital and 28 fewer drinks per person per week than patients who do not receive SBIRT. The Substance Abuse and Mental Health Services Administration, an agency of the U.S. Department of Health and Human Services, has implemented SBIRT as a model program in several other states.

According to an April 2005 Annals of Surgery study, hospitals can expect to save $3.81 for every $1 spent on alcohol counseling for injured patients. Furthermore, a recent analysis by Ensuring Solutions to Alcohol Problems, a George Washington University Medical Center program, determined that we in Hawaii could save more than $6 million a year if emergency room patients routinely received SBIRT.

IF IT'S effective and cost-efficient, what's preventing hospitals from adopting SBIRT as standard practice? The answer is an obscure Hawaii statute known as the Alcohol Exclusion Law, which allows insurers to deny medical coverage for individuals injured under the influence of alcohol or illegal drugs. Since documentation of alcohol or drug intoxication can result in denial of payment, hospitals have a disincentive to screen patients.

The AEL was adopted by most states almost 60 years ago, when alcohol and drug problems and their treatment were not nearly as well understood as they are today. There is no evidence that the AEL has any deterrent effect on people's drinking behavior, nor is there evidence that it has saved insurers money -- in fact, insurers likely pay more in the long term for unidentified and untreated drug and alcohol problems.

In 2001 the National Association of Insurance Commissioners, the same organization that had promulgated the AEL in 1947, recognized the law's perverse unintended consequences and called for its repeal. Since then, many other groups have joined the NAIC and publicly supported this initiative, including the National Conference of Insurance Legislators, American Medical Association, American Bar Association, Mothers Against Drunk Driving and Emergency Nurses Association.

THE TIME has come for Hawaii to establish and fund pilot SBIRT programs and to join the seven other states that have repudiated the AEL since 2001.

Our administration has introduced legislation this session in both the House (House Bill 2401) and Senate (SB 2364) to accomplish these goals. I encourage you to contact your legislators to urge their continued support.

Working together, we in Hawaii can make a happier ending -- in both human and financial terms -- to the story of emergency room patients with alcohol and drug problems.

For more about the Hawaii Drug Control Plan, please visit www.hawaii.gov/ltgov.

---