Fact: Right now, America is facing an opioid epidemic.
We know this because we’ve seen the numbers. Americans consume 80 percent of the world’s opioid supply, and 142 citizens die every day from drug overdoses. Since 2000, the mortality rate for opioid overdoses has risen over 200 percent.
Those statistics are staggering, but it’s easy to hear numbers without understanding their true impact. Over the course of the last few years, we’ve seen a trend of opioids being prescribed inappropriately. Data supports this, too. In 2015, the number of opioids prescribed was three times as high as prescription rates in 1999.
Learning to combat the opioid epidemic starts with defining the prevalence within a geographic area. The word “epidemic” is used broadly now, but the rate of abuse varies throughout the country. It’s difficult for leadership at the state and county government levels to unpack that word and put it in perspective for their populations. On one hand, there are clinicians who may inappropriately or unnecessarily prescribe opioids, and we can identify and track some of that information. On the other hand, recent research is showing that rates of addiction are increasing across the country – and that increase is not only because of prescription abuse.
What can leadership at the state and local level do to curb and mitigate this upward trend? It's one thing to have insight on what opioids are prescribed and in what situations, but how do we establish whether patterns can be predicted across a population? How do we identify geographic areas that have widespread opioid abuse so that we understand where to concentrate our efforts?
We look at the data.
Data can help us understand thresholds and how big the problem is in a state, county or even zip code. With better access to prescription data, and by generating knowledge and actionable insights, we can understand not only patterns but usage rates by region. From there, we can extrapolate conclusions that empower us to take steps toward preventative care, rather than reactively treating patients who have become addicted to opioids.
Statewide prescription drug monitoring program (PDMP) data is a popular (and in some states, mandatory) tool for identifying individuals who may be opioid abusers – people who go from one doctor to another or are frequently in and out of the emergency department (ED) for the purposes of obtaining an opioid prescription. This data can help deter clinicians from prescribing opioids to an at-risk patient.
When PDMP data is available to the whole care team, government agencies and other parties, we can take treatment for those individuals a step further by layering in population health management strategies. Statewide data can inform government leadership and law enforcement of the geographic areas or populations with a higher risk or likelihood of opioid abuse and can lead to public health programs focused on prevention and substance use disorder treatment.
Knowledge developed using machine learning or artificial intelligence methods can provide insight for a health care organization, provider network, state or others that have ownership for a population and its associated risks. Coupled with electronic health record (EHR) and PDMP data, algorithms can incorporate a person’s social determinants of health. When clinicians have this data in front of them, they’re better equipped to identify at-risk patients or potential abusers and anticipate how their prescription decisions might affect one patient versus another.
This knowledge can also better inform public health programs for opioid abusers and treatment options for patients – particularly at-risk patients who may need an opioid alternative to help manage their pain. Clinicians are better able to decide if there is a legitimate reason for prescribing opioids – if someone has just had surgery or if they're a cancer patient, for example – and can offer the insights to look forward and determine that person’s likelihood of becoming addicted.
Recently, I had an opportunity to watch an opioid encounter within an acute setting when my mother had knee replacement surgery at CoxHealth. While in the hospital, she was prescribed opioids. I was incredibly impressed with how the clinician addressed prevention: He was very thoughtful about educating my mother on opioid usage and the risks associated with the dosage. “This is what I'm sending you home with,” he said, “and it's not meant to be scary – you need this because we need you to be moving and you're going to be in a lot of pain.” The clinician further explained that the pain would change over time and was very descriptive about what it might feel like at the time for an appropriate transition to an over-the-counter opioid alternative. He educated her on certain warning signs associated with opioid usage over an extended period of time.
That type of coaching at the patient level is so important, along with a detailed protocol to identify patients that warrant an opioid prescription. For health care organizations, establishing best practices when it comes to prescribing opioids is essential. Here are some strategies for health care organizations looking to combat the opioid epidemic:
As in my experience with my mother, hospital leadership and clinicians should incorporate a protocol of patient education anytime opioids are introduced. But the education doesn’t begin and end with the initial clinician-to-patient conversation. Clinicians should be coached on how to manage patients they believe could be at risk or are already abusing opioids. Additionally, the broader public health system should do what it can to raise awareness for the widespread nature of opioid abuse and the warning signs.
Monitoring opioid prescriptions is critical. It can help identify areas where clinicians or pharmacists are lax in their vigilance to monitor opioid activity. The ability to identify and intervene with education, training and tools to support those individuals writing and filling prescriptions can give heed to long-term, responsible pain management.
It’s not enough to simply identify people who are at risk for opioid abuse and addiction. The other side of that is helping those people get the treatment they need – which can require care coordination with extended members of the care team. For example, when a clinician encounters someone coming to their facility clearly intending to obtain an opioid prescription, rather than sending them away without the script, the clinician should engage a care manager, health coach, behavioral health services or other treatment options.
By connecting the data in a meaningful way for insight and surveillance integrated with a care team approach for coaching and coordination, we have the power to proactively engage an individual before they become another statistic.
We believe in an integrated health system that meets the patients where they are, regardless of their condition or needs. With our comprehensive health solutions, health care providers can help patients live a more stable life by providing holistic, data-driven, preventative and supportive care plans and services unique to each person. Learn more here.