How One ER Doctor Tackles Opiates

Aug 31, 2017

Dr. James Black wants opiate drug seekers to know not to look in his emergency room.

“You know, we're not going to be easy prey, so to speak, for people with repeated usage,” Black said. Black is the director of emergency medicine at the Phobe Putney Medical Center in Albany.

In the context of national trends, Southwest Georgia doesn’t have it as bad as other places. Opiate use is in decline here, but Black said he has seen his fair share of overdoses.

“In the last shift I worked, in the emergency department on my 10 hour shift, we had at least four that I'm aware of,” he said. “And I've had case where people have dropped people off at the front door of the hospital and the patient is blue and not breathing.”

Black stresses that isn’t every day or even every shift, but opiate overdoses do happen.

“It is an issue in Southwest Georgia,” he said. “Make no mistake about it.”

James Black is the director of emergency medicine at Phoebe Putney Medical Center in Albany. He says his ER will prescribe fewer opiates than the Georgia law allows.
Credit Grant Blankenship / GPB News

By in large, opiates in Southwest Georgia are prescribed outside the urban center of Albany, most of them being prescribed in an arc of rural counties further west by the Alabama border. Still, Black said the Phoebe Putney emergency room is part of a circuit of medical facilities addicts take when on the hunt for drugs.

“You'd be surprised the the number of people who go to several different cities in a day's time seeking those prescription medications,” Black said. He said there are some obvious signs of drug seeking.

“Some people will frankly tell you 'I'm out of my medication, I'm having pain, I need you to treat it.'” he said.

Other people are less up front.

“They'll complain of things that are hard to detect or that takes time to detect hoping to get some opioids on the front end,” Black said.

Physicians don’t have to simply rely on their judgment when it comes to whether or not to write the prescription. In the age of big data, doctors can now look up a patient’s medication history.

“We're searching the prescription drug monitoring data base,” Black said. That data is administered by the state of Georgia. Black and the doctors he works with also have Phoebe Putney’s own records to look through as well as a Drug Enforcement Administration database.

“So it's becoming a routine to do that kind of investigation,” Black said.

This sort of inquiry is just a part of a patient’s triage when they hit the emergency room doors.

“But now when you are approaching every patient in the back of your mind you also want to know is there something else that may be involved such as drug use or abuse,” Black said.

If the research reveals a pattern of opiate overuse, Black said they just won’t make the prescription.

Still, some people need pain relief and are discharged from the Phoeby Putney ER with an opiate prescription. A Georgia law that will go into effect next year will limit those prescriptions to three days of medication or 26 pills. Black said that is too much.

“That is a lot. So we don't approach those numbers,” Black said. “You're not going to get more than three days of medication and more than 10 to 12 pills, much less the 26.”

Black said he hopes in Southwest Georgia, that’s just common knowledge.