Dr. Bograkos, Left, pictured with Ron Noble, Secretary General of Interpol

Come to any ACOEP event long enough and you are sure to meet William Bograkos; an indefatigable force, with deep roots in EMS, military service, world disaster medicine, and addiction medicine. He is now the Board Chair of the American Osteopathic Academy of Addiction Medicine and is a conduit between the very linked worlds of addiction and emergency medicine.

In a recent issue of The Pulse Dr. Bograkos shared his views on the natural partnerships between emergency physicians and physicians in addiction medicine. Below is more from our conversation with Dr. Bograkos.

 As always, we welcome your comments, feedback, and questions in this ongoing conversation! 

ACOEP: What do specialists in addiction medicine wish that emergency physicians knew?

Dr. Bograkos: I recommend that AOAAM offer the ACOEP a yearly presentation on “Screening, Brief Intervention, and Referral to Treatment…” Emergency Medicine physicians are very capable of diagnosing and stabilizing acute intoxication and delirium.  The addition of a yearly presentation on SBIRT will improve our clinical skills.  “To find health should be the object of the doctor.  Anyone can find disease” (Dr. A.T. Still).  We are physicians not technicians.  This is the “difference a DO makes.”  I believe SBIRT lectures could be followed by a review of Neurocognitive Disorders.  The DSM-5 now includes TBI (traumatic brain injury and toxic brain injury) within the Neurocognitive Disorders.  Just “say no” stops the drug dialogue.  Discussing addiction as a brain disease (NIDA) maintains the dialogue.

The AOAAM offers an eight hour CME called The Essentials of Addiction Medicine at OMED every year.  I realize ACOEP meets at a different site in October but collaboration at ACOEP Spring Seminar would display great collaboration and communication between disciplines.  We (ACOEP) have offered several lectures on TCCC / TEMS during Spring conference and we realize most TCCC / TEMS deployments are associated with drugs.

ACOEP:  How can we work together to fight, not just the opioid epidemic, but all forms of addiction through treatment?

Dr. Bograkos: During my EM career I have picked up the phone and called AA for people in crisis.  50% of trauma patients have alcohol on board.  40% of motor vehicle fatalities (dead in the golden hour) have alcohol on board.  Emergency medicine physicians are a vital part of Psychiatric Emergency Services.  It behooves us to develop stronger relationships with our partners in Psychiatry and Addiction Medicine.  We need to know who to call and when to call.  We also need to develop stronger, more resilient communities and Psychiatric Emergency Services.  Ideally our ACOEP residency programs would be involved with Addiction Medicine Centers of Excellence.  We are the frontline in “the war on drugs” and “the opiate epidemic.”

My first article, Domestic Terrorism, appeared in the “ACOEP Newsletter” [now The Pulse] Volume XXIV No. 3 July 1999.

I have taught chemical and biological preparedness for 25 years now and believe the only way to contain and control an epidemic is through coalitions of dedicated stakeholders.  The World Health Organization refers to bioterrorism as a “deliberate epidemic.”  The current drug epidemic is a deliberate epidemic and a significant point source is transnational organized crime.  Our prescribing habits and treatment of pain in the Emergency Room can always improve and I share www.DVCIPM.org as a reference for integrative pain management with the reader.  The DVCIPM lists OMM among “best practices” for integrative pain management in its Task Force report to the Army Surgeon General.

Other recommended websites for our members include www.WHO.int , www.UNODC.org , www.ONDCP.org and www.CDC.gov  Both CDC and WHO templates for “deliberate epidemics” begin with passive surveillance (phase 0), move into active surveillance (phase 1), then continue to expand into containment and control of the outbreak (phase 2).

Emergency Medicine and Addiction Medicine physicians would benefit from coming together in the pursuit of an operational plan.  We don’t need a Task Force.  We need to share “best practices” and “lessons learned”.  We need to walk our talk, communicate, coordinate, and cooperate.  We are living in the disaster zone and have seen the casualties.

ACOEP: What do you feel are the largest factors in addiction not being treated in a meaningful way, particularly as it relates to the emergency room?

Dr. Bograkos: My recommendation for ACOEP members is to attend and document training in Screening Brief Intervention and Referral to Treatment.

My recommendation to EM Directors is to identify Addiction Medicine subject matter experts in the community and develop networks for referral.  We should discuss standard operational guidelines for Substance Use Disorders with our hospital administrators and their PAO/PIO.  Emergency Medicine continues to serve as the intersection between hospital systems and the communities we serve.  We obviously play a vital role in the health of the community in the prevention of trauma associated with substance use and in the treatment of our communities.

ACOEP: What tools should emergency physicians have in their arsenal in dealing with addiction issues?

Dr. Bograkos: First recommendation for ACOEP members is to read the DSM 5 Substance Use Disorder update.  EM physicians encounter many patients with DSM 5 diagnosis.  We should communicate, coordinate and collaborate with our colleagues in Addiction Medicine / Addiction Psychiatry.  Substance Use Disorder is a chronic disease.  I realize that those needing referral and treatment exceeds access to qualified clinicians.  Hospital disaster plans are addressing behavioral health.  Recommend we update these plans to address the current disaster.

I have often utilized www.biausa.org for resources on concussion and brain injuries.  Recommend strengthening partnerships with National Alliance on Mental Illness www.NAMI.org at state, regional, and national levels in order to expand and advocate for greater resources.

All disasters are local.  Addressing Substance Use Disorder in our communities addresses community resilience.

ACOEP: What are some meaningful ways that our colleges and members can collaborate to address the addiction epidemic?

Dr. Bograkos: The UNECOM AOAAM student chapter recently shared a viewing of Chasing the Dragon with other student clubs in New England.

Chasing the Dragon is a DEA / FBI sponsored documentary about the current opiate epidemic.  I attended a public viewing hosted by the Ocean City Police Department and the National Association of Drug Diversion Investigators www.NADDI.org   This brought local, state, federal Law Enforcement (LE), and Health professionals together for active dialogue.  Recommend that our AOAAM, ACOFP, ACOEP student chapters unite at the COMs and sponsor a public viewing of Chasing the Dragon.  Invite local LE, NADDI chapter, NAMI, EMS, and other stakeholders.  I wrote an All Hazards Emergency Operation Plan for Baltimore County Public Health in 2004. Public Health was beginning to address deliberate epidemics.   We have to bring all stakeholders together for appropriate needs assessment and course of action within our communities.  Drug trafficking is a deliberate epidemic.  Revisit our deliberate epidemic plans and adapt to the current epidemic.  Our COMs and Osteopathic hospitals could utilize a documentary like “Chasing the Dragon” to unite communities in addressing the current “opiate epidemic.” Dr (Major) A. T. Still called his post-Civil War opiate epidemic the “Soldier’s disease” and stated “An Osteopath asks no favor of drugs” (from Doctor A.T. Still in the Living by Robert E. Truhlar, DO).  Let’s address the addiction epidemic by displaying “the difference a DO makes”  through strengthening our community infrastructure.  Coalitions are needed to contain and control outbreaks.  All disaster plans emphasize communication, coordination, collaboration, cooperation and unity of effort.  The current public health disaster requires a whole of community response.  COMs and Osteopathic hospitals play a vital role in the communities we serve.  Let’s invest in the students and invest in the future.