Joseph D’ Orazio is the directer at the department of emergency medicine, division of medical toxicology and also works in addiction medicine. Dr. Joseph talked about the overdose crisis from the perspective of an emergency physician. He grew up outside of Philadelphia but is familiar with population and how the epidemic has grown. Dr. Joseph has been working at Temple Hospital since July 2016 and has a board certification in addiction. He created a process for people who get admitted to the hospital due to infections from injection. He runs a program that gets people started on suboxone and they also have the opportunity to get linked to a methadone program. Dr. Joseph has also contributed to an existing program, the Temple trust clinic family medicine office is a now a methadone clinic. I thought it was really important that Dr.Joseph pointed out that its not just about emergency medicine but addiction medicine as well as to how it is treated.

Dr. Joseph also brought up how language matters and how many people who work in hospitals actually do not use the right terms or language when they come across a person with a substance use disorder. It was very disheartening to hear Dr.Joseph talk about how he can overhear people who work in the hospital talk about people who use drugs in a degrading way, on a daily basis. He mentioned how patients come in and let him know how they hear nurses and other people talk about them and how they’re are aware that people think they are ¨pathetic¨ or ¨ losers¨. I don’t really understand why people in the medical field are not trained and educated on this topic and I think it should definitely be a requirement. Considering the fact that Dr. Joseph mentioned how 4 times as many people die from drug overdose as they do from homicide. Which is interesting because Dr.Joseph pointed out how there is a whole trauma center full of resources with lots of outpatient services but there is just one person on campus for drug overdose, which is Dr. Joseph himself.

I thought it was GREAT how Dr.Joseph compared two cases, one being a patient with diabetes and the other a patient with a substance use disorder. He explained how taking care of diabetes requires a person to take medication and monitor their diet. 60% adhere to medication regimen and 30%adhere to diet/ behavioral changes. Sometimes people come into the emergency room because they are not taking care of themselves by following their regimens which causes them to lose control of their health. This case would be treated normally and the person would be provided with the care and treatment that they need. However, when a case is brought up about someone who is using, people tend to look at it as if they are weak and like its an ethical problem. I thought it was a perfect example and also thought it was important that he mentioned how a person with a substance use disorder should be treated just like a person with diabetes or asthma would be treated.

I also thought it was really important how Dr. Joseph explained that addiction is a disease not a choice. He explained how in the brain, the frontal lobe is for problem solving, judgement, impulse control, and reasoning. While the nucleus accumbens is for reward, euphoria, pleasure, and preservation. When someones frontal lobe is not properly functioning the nucleus accumbens takes over, it is what helps us survive. This is the part of the brain that ultimately forces a person to use again when the frontal lobe is not functioning properly. Dr. Joseph explained how sometimes when people come in right after using, he could have sat down with them to make a great plan to help and treat the person. However, if the person ends up getting in a fight, is hungry, or is going through withdrawal, the frontal lobe will stop functioning which is when they go back to using. He also explained how some people have a genetic predisposition and others underlying problems such as anxiety depression, while other people who are exposed to the drug will develop it throughout time. I think that this specifically is also something that people should be required to know, especially those working in the medical field. Understanding the root causes of addiction and how it affects a persons way is only one of the keys to help solve this epidemic.