Emergency Radiology Plays Increasingly Critical Role in the Opioid Crisis

By Beth Burmahl

As with many areas of healthcare, radiology is feeling the impact of the opioid crises gripping cities across the country.

Almeida

Emergency radiologists are seeing a dramatic increase in patients coming into emergency departments (EDs) with complications related to substance use disorders of highly addictive opioids like heroin, fentanyl and oxycodone.

The skyrocketing numbers present challenges as well as opportunities for emergency radiologists who are on the front lines of the substance abuse crises every day, according to the presenter of a Thursday session, "Radiology in the Midst of the Opioid Epidemic."

"The emergency department is frequently the gateway to the healthcare system for patients with substance abuse disorders," said study author Renata R. Almeida, MD, MSc, research fellow in the Emergency Radiology Department at Massachusetts General Hospital, Boston. "However, the literature on imaging findings of substance abuse complications is very limited. It is critical that radiologists have a high level of suspicion for substance abuse and recognize the imaging features of its complications, even when a history of substance abuse is not available."

Dr. Almeida presented results of 12-year study at MGH showing that emergency radiologists have seen a steady increase in patients with substance abuse disorders presenting in the ED between 2005 and 2016.

Researchers studied the association of imaging findings with mortality and opioid prescription history among patients with intravenous substance use disorders (IV-SUD) presenting to emergency radiology.

The study group included 1,031 patients imaged from 2005 to 2016 for substance use-related complications. Of all the patients, 66 percent were men, 78 percent were white and the mean age was 36 years.

Non-sterile injections were the most frequent cause of imaging findings, and soft tissue swelling was the most frequent complication of injections. Fifty percent of the substance abuse related imaging complications were seen on musculoskeletal exams.

"Complications were most frequently related to skin and soft tissue infections caused by the use of non-sterile needles," said senior study author Efren J. Flores, M.D., emergency radiologist at MGH.

History of opioid prescriptions before the first imaging exam was present in 310 (30 percent) cases with a mean of 10 prescriptions per patient. History of opioid prescriptions was significantly higher in women (36 percent, 128/352), than men (27 percent, 182/679). Mean time from opioid prescription to first imaging exam was 51 months – significantly shorter in men (45 months) than women (51 months).

Overall, 121 of the 1,031 patients, or 11.7 percent, died before the end of the study period. The mortality rate was 14 percent for patients with a positive imaging diagnosis of substance-abuse-related complications – significantly higher than the 10 percent rate for patients with no such history. Five-year mortality rates were also higher in patients with prior opioid prescriptions and with imaging complications.

Taking a Multidisciplinary Approach

The study revealed that patients with substance abuse imaging complications have lower survival than patients without imaging complications, emphasizing the important role of ED radiologists.

But while ED radiologists are highly skilled in critical areas of emergency, Dr. Almedia said there is still an opportunity to improve strategic training that integrates all of the multisystem substance abuse-complications in ED radiology — primarily because incidents of opioid abuse have skyrocketed so quickly on such a wide scale.

"Radiologists should play an active role in patient care by alerting the multidisciplinary healthcare team for warranting health and survival of this vulnerable patient population," Dr. Almeida said. "We believe our study results can draw the attention of academic programs to the need of specific training in substance abuse imaging."

For instance, radiologists can encourage patients to use sterile needles, inform them about needle exchange programs and advise them to use alcohol at the injection site to avoid infections. Radiologists can also help steer patients into programs or connect them with recovery coaches, both in the hospital and community, to help them with their illness.

"Radiology is central to patient care in the Emergency Department setting," Dr. Flores said. "We need to be actively advocating for these patients and giving them an opportunity to take steps into recovery."

View an interview with Dr. Flores and Dr. Almeida here.