Joshua Lynch - Clinical Assistant Professor of Emergency Medicine

On Target with Penny Wolfgang
Sunday, September 2nd

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This is on target with penny Wolfgang a program that takes an inside look at what is happening in Western New York with news features and special guests. Now here's your host how many Wolfgang. Hello everybody and thank you so much for joining me today and on target. As you know we're here every week and we tried to talk best subjects that we think are important to an inch sting in educational and topical for all of us who live here in the Western Europe community. There's probably no more topical subject. Than in the opiate addiction and the crisis that we and as a nation have been facing for several years are guiding this and I always want to take an opportunity when I habit. To meet and talk to people who are trying to. Address this issue in one way or another well whether it be through. Medical means whether it be through public relations whether it be. Counseling. I'd there's you know many many aspects to. The issue into treating the problems. So recently I and pleased and honored to say them on the LP a task force for and Erie county recently we have meetings with all the different. Agencies and groups that are. Involved in trying to meet this bra problem and this crisis and one half the speakers. Was I thought so important and has so many non interest in Faxon was invalid such financing program that I asked her feud come to uncharted. And it address it and talk show us about it and how so he's graciously here doctor Joshua lynch. And doctor lynch is an emergency physician. Three UB MG. Emergency. Physicians and emergency medicine it's called. And he is involved with not only this issue but of course other issues as well but a program that I think he's going to describe to us has been. Making a difference really a landmark program that is making a difference here in Western New York anyway and if not it. A prototype probably for the whole country thank you for joining us to actually going to be I think I made that happen death. Well first you'll just let me get to me go back in and give your credentials. A in a better way to my listeners. By asking you what your background is. I grew up here and western new York and train an emergency medicine. To US UV and the that it's associated hospitals collider EC MC. Let there be a children's. And down not now work for you BMD emergency medicine primarily at the collider hospitals and EC and seeing. And also do some work as a medical director for mercy flight. And over the last few years have found myself very involved and working to try to. Look to combat the open date addiction crisis. And not only in Western New York are really across New York State and more and more kind of across the country that are. You know when I said and that emergency medicine and I was thinking that immoral lacked moral less it is 1000. Not just opiate addiction like drug addiction but a lot of other issues and people end up in the emerge. C room aren't. Right so. You know we we Arab kind of the front lines of medicine along with the primary care providers. You know our counterparts that work out in the house in the offices on the community. And we. We we really are the ones that kind of confront. Illness and injury really has it comes as it comes and there aren't necessarily we never really Canada schedule for the day so. We really kind of need to be ready to not only handle things dramatically. But I also what are you going to do when they're ready to leave the emergency department and we're we're very well equipped to handle patients that command with a traumatic injury and they go to the operating room. Patience I commend his chest pain neither get discharge to follow with their cardiologists are their primary after. Or they go into the hospital and go get a procedure to honor a stress test. And you really kind of the the what sparked some of us as we realize that. You know we can take care of patients they command was addictions problems and in the in the emirates here and we can resuscitate them if they've overdosed or. We can help to try to treat their withdrawal and the emergency department but. We realized that we didn't really have much to offer them when they left. And if we kept them in the hospital. You know things Virgo things would go fairly well I think in the hospital but. When they're ready to lock out the door we'd we didn't really have much to offer them like we did all these other chronic disease processes. Like if somebody came and wish. An asthma attack glory and begin thinking something that was immediately exit chronic do you know what it what are diabetes. And that they're driving is out of control we admit them to the hospital get under control benefits you know. Just a little bit worse today than me you know stabilize them in the senate back to their their primary doctor. Or their endocrinologist. And and we were you know we realize that a lot of us have been frustrated that we while we don't really have with the same. The same rock solid follow up likely think we should for patients with a addiction problems. So then it will what what did happen Hannity develop and also this Tom. That this is really I think. And an example of unprecedented collaboration that's happened across the medical community and even Western New York is known for you know working together and and kind of all chipping in and helping out. For many many things medical and a medical. So. We we realize that you know we need to get these patients. It's treated them the most efficient manner and then emergency department. And working with a group like UB MD emergency medicine com. And that has to do research component and evidence based practice and all kinds of people working to make sure that. The care that we deliver is cutting edge is scientifically backed. Evidence based. So we so that that that part wasn't that. Challenging to figure out what we what we needed to do right in the hospital but but engaging the addictions clinics that we're thankful and fortunate to have a lot of them around. Western New York. Think gauging them to get together and kind of come together with a common set of values and having them be willingness take some of our patience and a pretty quick manner after they leave the hospital. That was really kind of the bigger job than. And the working with the Erie county open it task force. And the health commissioner doctor Gilbert Steen and all the agencies that are represented their from police departments to counselors to Nixon's connects to. The hospitals to the EMS services to all. All over the spectrum. Really kind of spark the idea of you know let's just get everybody together and try to create a network. Just like we would of primary care providers are cardiologists are there any other specialty. That. That we know that at that practice is kind of along the same principles as as a group like UB MD does. They're providing evidence based care of their fair. Then they can get patients and and a fairly you know timely manner so. We we engage clinics and now we've we have 27 different office locations or participate. That are willing to take are patience you know within a within a couple days leaving the hospital. And I think most importantly. Is that all all of these clinics have have agreed to provide. You know excellent care have and have agreed to it really can have except pit the patience with all of their car abilities are complexities that they bring left. That into the clinics and we've you know been thankful to to have such a great partnership with all of these organizations. Too many to list. That then that now there is a stay in place for the patients to go when they leave the hospital. And and it's timely manner. Now there is our and going back on a couple of steps also with the treatment in the emergency room issue and the opiate addiction. Issue I originally against there was a lot of we college opposition to retreating. People with from overdoses with medicine. And would continue to treat them with medicine right so that's something I've. I think you've overcome and you've worked to new educated at others about. So. That there was actually allow that said that you can't treat opiate addiction with Opie and it's. And and that's part of the premise or the foundation of the an additional extra training that he might have heard that that physicians and he's nurse practitioners have to take. To be able to prescribes a box and our people and our friend much which is is one of the only evidence based Henna and and scientifically proven ways to reduce. Or I'm sorry to. Increased treatment compliance over the long term. So getting. Getting physicians and p.'s nurse practitioners to give up in and invest another eight to eight to 24 hours of additional time out often times on their own. To be able to get the certification to prescribe the medicine isn't necessarily easy. So get giving credit to some of the folks at the university of buffalo. And that our chairman doctor rob McCormack. Who who really kind of led the charge to rally Powell. Roughly 120 of up to the ER providers docs PA's that work for our group. To encourage them to go through get the certification. So we can provide you know this level of care right in the emergency department which we now we've been doing for about a year. Explain what would happen. Before. In the emergency room what kind of achievement and a person would guessed there was suffering from an overdose. So it's. Thankfully EC MC has had drug and alcohol counselors position right in the emergency department for a long time and they have. Really taught us a lot about how what we do what we need to do right in the emirates department. However that that they're unique and an offering that service most of the other hospitals don't have the the opportunity to have drug and up unconscious rainy humorous department so what we used to do. Was really try to give them some medications in the ER get them feeling better and give them a list of phone numbers. To call when I got home. Now we we know how well that. Probably where he can fly in right probably. 1%. Or less so imagine getting home mentioned having. You know having the courage succumb to that ER and then want help. Which is hard for these patients. To do and we give him a lot of credit when they are able to you that police and the moments at the Phyllis to phone numbers and maybe some of the numbers didn't work but they call and they were offered in the Clement six weeks out. The likelihood that they're gonna keep trying it you know is very low and in the the the opiate addiction is such a strong disease that. That if you're willing to try for the day or two days and you're not getting anywhere to like that you're gonna keep trying his very long. Unrest in Casey just changing Hillis seem to on target with your host penny Wolfgang and we haven't this year with the staff to Joshua lynch who is an emergency physician with you bmg emergency medicine and we are discussing. A new program really that the doctor was involved with for treating for continuing treatment. I guess we would say of people who are suffering from. Opiate addiction now why is sit down and what's uniquely different about. Opiate addiction from any other addiction that. Person might come to be emergency room for treatment for. Well I think first and foremost it's it's. An acute life threatening disease really. So. Other other addiction certainly can can kill you but open interdiction. Can tell you much quicker and unfortunately you know we've seen people overdose and not be Rico not be revived. Even using one or two times even. So it it really goes across on tired of spectrum of people that have been using for years and years and years it just takes one time for them. You know for them to die so that the urgency there. There urgency to try to try to help this problem. It really needs to be there and I think we thankfully you know with cooperation from the university in from hole bother other different groups. They that have shared kind of in that and that idea that while we you know we really need to do something. This that this program that were able to refer patients into a whole bunch of treatment slots and a whole bunch of different clinics. Was really able to grow and and thankfully to get to the O shy foundation. For providing us with the grand introduction of the Erie county Health Department needs to be able to grow this program to the point that it is today with. Of over sixty appoint this appointment slots a week. Well across 27 different clinics. And the patient gets to choose where they go I mean really we wouldn't be able to do that without that the collaboration of all the people that I mentioned before about. You know importantly what but the support the Ochoa foundation and just last week there's an article in the New York Times that kind of highlighted. Hey hey it's a story. About it at the summit ER is that we're starting to treat opiate addiction in the ER intend. The that title there's a title or the first couple lines including the fact that it that's a very rare. Let that this is happening in and a lot of us kind of took note to then say and said you know while it's actually not very rare especially in buffalo. Mode you can go to pretty much any hospital in the greater buffalo area and have access to this network and and I think this network is. Is one of the most robust treatment networks in the country. And them him it it shows that other people are taking note too like New York City Health Department and the Colorado state Health Department in New York City. Asking kind of like how did you do how did you do this and it's it's. As complex as it sounds it's really about building relationships and that's what's great about buffalo is. The clinics have stepped forward Geary county health Herrmann stepped forward. QB has stepped forward collide Leo Shaq foundation are offering to help then and kind of identifying those those groups in the community which we have a ton of you know is really how it how it happened. It it's very impressive when you go to GOP test was meetings and so I have to see and you mentioned just a few. We a tone for patent of the different groups that are involved. Law enforcement group CE. The counselors the addiction clinic is me family is. I've failed in the last sailing lessons teach us a lot and teach us every single day. What where we need to stay focused and then they can ever for reality check us to make sure that. Things that we're working on developing at the task force in collaboration with a all these other different groups makes sense. Two people who have gone through it before. And when it's his talk a medically a little bit since I had a doctor. Locked up in studio here and the door closed. Of how. The effect what happens because we keep reading how serious and how. Thank you just said a person could actually die from both liked just using OP is two times not just forever. But not just three years or whatever what's different about their opiates then there is. I'm trying to think heroin or. Another I don't know Vento. So. So what were overseeing. Lately and is the is the potency of the opiates that are out there is much much higher. I'm so. The potency of of injecting fentanyl. It doesn't take very much to have a fatal dose. So. To the the they're what happens when you when you take an opener is that here respiratory to rate goes down in your drive to breathe. Goes down so typically that's that that's what happens is patients stop breathing. You know you might be thinking to yourself well the the use final in the hospital. That's of it in a very controlled environment it's actually a very good payment lesson when you know when used properly by someone knows what they're doing. I wanted to talk about them what they were explaining about how it affects the brain and tout this series effect that it has under brain which many people are not aware of the danger room. So. That I think the biggest problem is that that that dependency happens so quickly. So. That year the the body becomes physically dependent on having hoping it in this and in this system. So when you went and that's important because when you don't have any your system. You go through such an unpleasant withdrawal. That you psychologically while more even though you know it's not good. Yeah but you physically need it to function. So you know oftentimes the patients that we care for in the hospital and in the doctor's office and he Dixon's clinic. Are are are literally physically dependent on them on the medication. And they can't they can barely function without it so that the the patients that we see mostly now our patients that. That their life is nearly consumed by. By trying to stay out of withdraw so. They there were jobs suffers or family suffered their every aspect of their life in its entirety really except for. Using the drug. It goes away and becomes it becomes. And no less important or I guess less of a priority even though deep down they they value of those things they want. Those things to Foster and flourish they just can't because their body in their mind or so we just consumed. And not being withdrawal and just function. And we keep hearing in about the fact that. A lot of people become addicted peaked due to prescription. Legally prescribed. Drugs that they need for pain for after an accident or a back injury eyler. You know something like that in. I know what is that true and what is he signed in what can be done about it. It is and this is brought to light the the need for education at the it you know at the medical school level and not only just medical school but. Dental school chiropractic school and nursing school physical therapy. Really all all the disciplines of healthcare. We realize that you know we've we haven't done a great job at educating you know the future of Madison. How to responsibly treat pain and how to responsibly prescribe OP and it's and also. What when and how to responsibly prescribed pain medication that's not appealing it's. And that we can and you know the university of buffalo has has taken it a great stance on this with. With. Multi disciplines that are starting to incorporate you know appropriate use of pain medication and non opiate pain medication and how to treat pain. Into their curriculums. To stay ahead of us so they graduates that they're putting out our you know responsibly trained practitioners. But there's the other side to this which you hear people saying now that you that you're not easy you know to say. Have a friend of mine for very good example had a car accident. And have her back in her spy plane or what they sent her shoulder I mean whatever she was in terror and pain. And she was only able to get to and Satan that Tylenol groceries and you know something I said. And where as I think a few years ago she'd most definitely would have been described. What's that what's his turn things under coroner yes yes yes. A unit a think. There are some some clinicians that have gone that that they've allowed the pendulum to swing in the and all the way to the other direction so. Patients well of that occasionally come into the camera into the pharmacy. C someone like myself for one of my colleagues and and there we often hear that while my doctor doesn't prescribe pain medication period. So you know it slight I don't personally know of that's. That's really the solution either. It takes a little extra work in a little extra time nick to explain to say hey listen we're gonna prescribe you a small quantity of harder code on. A smock of various talk on any must relax us but we're also gonna prescribe you and -- or an anti inflammatory medication and here's a we want to view we want you to take. This Madison most of the time and if your pain is you know on controller intolerable. Then take you know take one of them opiate pain medications but. But gone gone are the days really that we should be prescribing quantities of ninety's. 400 needy even sometimes had a coat on tablets. And just letting the patient go on their own with that big battle to figure it out for themselves. So other kind of other techniques that. Are being uses will give you know five days I but narcotic pain medication and if you're still in that much pain you need more than need to come back so we can see UN. Had to decide what you know what the most appropriately pain management regiment would be for you. I needed to go back to something that we are talked about originally and it was that. There was a great hesitation or pint content think of didn't expect opposition to treating people with snow are kid with. Not just knocked hand but I can't think of the other is that they used to cheapen and because but I think in Europe and the education had to take place to show that this was really the only way. Chipper to treat people who are addicted to get them both a some box and threat ignorant yes. You know so. So the Medicaid so so box and as part of the treatment strategy called medication assisted treatment or MET. And that also includes medications like live Charl are now tracks on or methadone. And the then evidences shown that those using those types of medications and in conjunction when it's counseling. Horse you know as to who's counting either group or individual or combination of both is really the key. And medication. And diaphragm and doctor Paul Updike who we work with closely who who now works and addiction addiction medicine. He he puts it very well the medication does the heavy lifting. Of working and addressing the problem in the counseling. And you coming to the office and and being responsible and being accountable kind of takes care of the rest. So they're really using the two tools together. You know I think is what really needs to be done and what what really and it has been shown to be successful now. Getting patients linked to programs that provide both. Is really was really kind of the premise of what we. We're together with you BM DM associates' foundation and the Health Department to try to get it patients' access to that type of treatment that we know that works. That was the challenge race and also we hear people say all the time I can't believe that. Somebody would be treated as an arcane and three times in one day three times in a week three times and ten times in a month a round how you how we do that have to do that. Yet it quietly do it's actually very easy I mean one it's the right thing to do. And come to the does this open over an addiction is a chronic. Relapsing disease. It's a chronic disease so that the easiest waited to relate this to us is to is to look at the patient with diabetes. And when they come in and they have be in cake or eating too much or their Pletcher is out of control we don't stop giving them insulin. We continue to treat them and we work through them and kind of hold her hand as they sit at. And it took ten stemming shepherds who is well yeah. You can't hear how two weeks that I mean we we oftentimes joke with patients and sailor accusing you gotta we got a real acts like got to cut down roller be careful. I am but we see the same thing to patients with a doping problems as pleasant. We understand that that relapse and and making a bad decision is part of the disease. We we get it. We're here for you will treat you. You know be very you know be careful next time. But we we as health care program professionals poets where patients to take care of them whether. There diseases the onetime cure or something that we need to work with them prolonged period of time for. He mentioned they relapse issue I was gonna say you I learned from my OP Tesla Sweeney's. And that. It's such a it's insipid so. And it hangs on so much this detection and disease that. You can expect I think. Heard seven even may be passed at least seven times that a person is going to relapse until they actually can get this out of this system rent being right. Rehabilitated race I mean it just look at it. Look at any any chronic disease I mean. Patients come in with out of control blood pressure all the time how many hits did we all know someone is trying to quit smoking rate and they've they've tried many many many many times that we don't. We don't give up on them. So you know I think that this should really be viewed. And note no differently than any of those things that we just talked about. And in the public goes Vito awareness of the public is that I know you've been. And I'm working on the and and you win every meeting the test for us and all other groups. The eliminating the stigma and making people realize that you know this is an addiction and it its medical and has retreated. Right rent. You know we've we've heard over and over and seen in the news that that this. This problem doesn't discriminate based on where you live for how much money maker what color you are poor or whatever really end. And I think that. That realizing that picked that. People from all walks of life struggle with this. Whether they are professionals or whether there homeless or whether they're blue collar factory worker or an office worker or an attorney. I have seen all of them many times and they I'll struggle the same exact place and they really don't deserve the best human that we can give. We're we're really really excited to learn about the successes program and then it's being. And it's so successful at other places other in this areas of the country even using it for an example so we thank you so much. I think actor Joshua lynch being with us today. And death thanks for listening everybody we hope maybe we've helped somebody in giving them some information that they didn't have before. Please join us again next week front target have a good week into by everybody. You've been listening to one target with penny Wolfgang. A program that takes an inside look at Western New York in our community. If you have any comments or suggestions. Please rate depending Wolfgang it's 500 corporate parkway suite 200 Amherst New York. 114 to six.