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Esther Choo @choo_ek
, 15 tweets, 6 min read Read on Twitter
Gail D’Onofrio, Chair of Emergency Medicine at Yale & national expert on emergency med’s role in staunching the opioid crisis, is giving the keynote at #SAEM18. Will push out highlights here.

She started with the faces of those lost to opioids. A knife to the heart.
(Side note: as a longtime mentor to me, D’Onofrio has never minced words. True with this talk: “Most doctors know very little about addiction.” Truth.)
She’s reviewing the pathophysiology of addiction and I’m think how so much of our life is spent chasing this neurotransmitter, dopamine. #saem18
D’Onofrio: Addiction is like driving a car and seeing you are about to hit a child. You want to stop with all your heart and mind. But the breaks don’t work. #saem18
WE HAVE EFFECTIVE TREATMENTS FOR OPIOID USE DISORDERS. Methadone
Buprenorphine
DETOX ONLY IS NOT ON THIS LIST
#saem18
“Medically assisted treatment” is a weird term. We don’t give diabetics insulin and call it “medically assisted.” It’s just the treatment. Speaks to the stigma of this disease. #saem18
What’s the deal with Vivitrol? D’Onofrio: Recent data is overstated. Has a role in the armamentarium. But be skeptical. Not first line treatment. #saem18
Why aren’t we using effective treatments more? (Even only 1 in 3 in addiction programs!) #nuts #nuts #nuts #saem18
WORDS MATTER. This is a disease. Diabetics with glucose in urine don’t have “dirty urine.” It’s positive or negative.

And “there’s no such thing as an ‘addicted baby’! 👶🏻 (right, @stephenwpatrick?) #saem18
Initiating opioid use disorder treatment in the ED is feasible and effective.

The Yale bupe study “should have caused an earthquake”... but barely registered across emergency care.

But the earthquake is coming, says D’Onofrio.

#saem18
Quick poll: if you’re an ED doc, what are your feelings about getting a bupe waiver? #saem18
She’s showing videos of leaders and innovators in emergency medicine working on this topic and I have chills over their awesomeness and dedication. Makes me so hopeful. #saem18 #opioidcrisis #heroes
We need:
1. More funding
2. Stop restricting access to bupe
3. Define, measure, & track quality of OUD treatment within EM
4. Develop further resources to support clinicians in acute care settings
#saem18
We need to change how we:
*Think about opioid addiction
*Talk about opioid addiction
*Treat opioid addiction
AMEN. An incredible & inspiring talk.
#saem18
Follow @DonofrioGail to track progress on this front
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