The U.S. is in the midst of a national crisis. In the past two decades we have seen increasing use, abuse and deaths associated with opioid medications.
Here are a few disconcerting trends*:
Prescribing opioids is on the increase. Approximately 20 percent of patients receive an opioid prescription for non-cancer-related symptoms or pain-related diagnosis in America. This 20 percent translates to approximately 259 million prescriptions or an equivalent of one bottle of opioids for every adult in America.
Health care providers are prescribing opioids for longer periods of time than recommended. The National Safety Council reports survey findings that indicate 99 percent of primary care physicians routinely prescribe potentially addictive opioid pain medications for longer than the three-day period recommended by the CDC.
People are abusing and dying from overdoses of prescription medications. Drug overdose is the leading cause of death in the U.S., with opioid addiction being the driver. According to the CDC, 52 Americans die every day related to opioid prescription misuse and abuse. Of the nearly two million Americans abusing prescription medications, 55 percent obtain them through family and friends or another type of diversion activity.
The annual cost of opioid abuse to the economy is in the billions. The U.S. spends almost $56 billion each year in lost worker productivity, health care expenses and criminal justice fees due to opioid abuse.
The number of innocent victims of pregnant opioid abusers is growing. The rise in neonatal abstinence syndrome admissions from 2004 to 2013 reflects the increased use of opioids by pregnant women. The risks and debilitating effects imposed on these soon-to-be-born children should be enough of a reason for all of us to look for a way to improve the use of these powerful substances meant to alleviate suffering – not cause it.
Many health care organizations, states and industry experts from The Joint Commission to the DEA as well support groups like Advocates for Opioid Recovery have been dealing head-on with the national opioid crisis. A great example is the state of Massachusetts which began its campaign on opioid awareness in February 2015, when Governor Charlie Baker appointed a working group to develop a plan to reduce opioid deaths. In June 2015, the group released 65 recommendations and a comprehensive action plan aimed at curbing the opioid epidemic, focusing on prevention, intervention, treatment and recovery support. In March 2016, Governor Baker signed landmark legislation into law. Through a special bill, several recommendations from his working group were included; most notably, prevention education for students and doctors as well as the first law in the nation to establish a seven-day limit on first-time opioid prescriptions.
St. Joseph’s Regional Medical Center in Patterson, New Jersey chose to approach pain management in its emergency department through holistic medicine. Click here to watch their story. Beth Israel Deaconess Hospital in Plymouth, Massachusetts addressed opioid issues by first listening to the issues being faced by its community, school system, police department, drug court and health care providers. They soon realized that an integrated system to treat both addiction and behavioral health did not exist. In October 2015, they launched an integrated program, funded by the Massachusetts’ Health Policy Commission and private donations.
With a goal of removing barriers between the emergency department, primary care physician offices and community behavioral health and substance use programs, the Integrated Healthcare and Substance Use Collaborative at Beth Israel Deaconess Hospital – Plymouth realized several successes in the first nine months of operation.
- The hospital encountered 1,500 unique mental health/substance use patients with 40 percent receiving referrals to community-based services
- The hospital installed a “MedSafe” medication kiosk for people to turn in medications that were no longer needed and collected 40 gallons within its first month, preventing the diversion of this medication into its community
- The Plymouth police launched Project OUTREACH with the hospitals integrated collaborative to provide in-home follow up 24 to 48 hours after an overdose and the Beth Israel Plymouth effort provided NARCAN® education and training to hospital staff and the community.
Next on the horizon, Beth Israel of Plymouth plans to work with the Massachusetts Hospital Association to expand prescription guidelines; develop a regional behavioral health emergency facility; educate insurance companies about opioid addiction/substance addiction is an illness and needs coverage; and help state legislators with the creation of new legislation and funding to properly treat patients.
As you can see, it will take a concerted effort and multipronged approach on the part of all health care organizations, and providers across the continuum of care to turn the tide on this national epidemic. Hospitals and providers can start today by:
- Reviewing Vizient’s comprehensive resource compendium on opioid stewardship. It gives leading and best practices to reinforce solid opioid stewardship and includes the resources we have gained through our Vizient Portfolio Stewardship Campaign.
- Joining forces with colleagues and peers across the country in an improvement collaborative to improve opioid stewardship, while also helping patients get the pain relief they need without developing a crippling addiction.
About the author. As senior vice president, performance improvement networks and advisory services, Julie is responsible for Vizient’s suite of performance improvement platforms, comprehensive databases, informatics, analytics, quality research and nursing leadership. She also provides direction for the Quality and Accountability Study, which is the basis for Vizient’s nationally recognized Bernard A. Birnbaum, MD, Quality Leadership Award, presented to the top-performing academic medical centers each year. Cerese’s substantial knowledge of clinical quality improvement was supplemented by her service as director of quality and infection control at Chicago’s Northwestern Memorial Hospital. Earlier she served as senior director of University HealthSystem Consortium’s clinical process improvement area.
*Centers for Disease Control and Prevention. “Overview of an epidemic.” https:/www.cdc.gov/drugoverdose/data/index.html (retrieved October 13, 2016).
Keilman, John. “Almost all doctors routinely overprescribe pain pills: survey.” Chicago Tribune, March 24, 2016.
Veeral N. Tolia, MD, Stephen W. Patrick, MD, MPH, Monica M. Bennett, PhD, Karna Murthy, MD, John Sousa, BS, P. Brian Smith, MD, MPH, MHS, Reese H. Clark, MD, and Alan R. Spitzer, MD. “Increasing Incidence of the Neonatal Abstinence Syndrome in U.S. Neonatal ICUs.” The New England Journal of Medicine 372 (2015): 2118-2126.