More than 130 people die each day from opioid-related drug overdoses, according to the Department of Health and Human Services. The ongoing epidemic has become a major public health concern across the country, and states have struggled with curbing opioid-related deaths.
Ohio had the second highest rate of opioid-related drug overdose deaths in 2017 — 39.2 deaths per 100,000 people, compared to a national average of 14.6 deaths per 100,000 people, according to the National Institute on Drug Abuse. Prescription opioids were the main underlying cause of these overdose deaths, accounting for 947 reported deaths in 2017.
Using Data to Track the Epidemic
Tracking and using overdose data is critical to identifying areas hardest hit by the opioid epidemic. NORC at the University of Chicago, a nonpartisan and objective research organization, has developed a National Opioid Misuse Community Assessment Tool for the U.S. Department of Agriculture, which integrates overdose mortality rates for counties in all 50 states.
Curious about the underlying data feeding NORC’s tool, America’s Essential Hospitals staff analyzed the raw data, which was shared with the association, for a potential correlation between high overdose rates and locations of our essential hospital members.
In comparing data from the two time periods — 2008–2012 and 2013–2017 — we quickly zeroed in on Ohio. Unlike other areas of the country, Ohio data for the later time period showed a significant increase in opioid deaths from 2008–2012, illustrating the struggle Ohio faces in the wake of the opioid epidemic. We then looked to see where our essential hospital members were in relation to the hardest hit areas. As we suspected, the blue dots on the map below illustrate that essential hospitals are, in fact, on the front lines of the epidemic.
Essential Hospitals on the Front Lines
Essential hospitals play a key role in opioid misuse prevention and intervention through innovative, comprehensive care approaches. Three essential hospitals in Ohio — The MetroHealth System, in Cleveland, UC Health, in Cincinnati, and The Ohio State University (OSU) Wexner Medical Center, in Columbus — are no exception.
Efforts in MetroHealth’s hometown of Cuyahoga County are considered a national model for tackling the opioid epidemic. In addition to providing critical recovery services and connecting patients to resources in the community, MetroHealth leadership worked closely with state officials on a public awareness campaign designed to educate residents on the dangers of opioid prescriptions.
MetroHealth has launched several initiatives and programs to provide comprehensive, coordinated care to patients with or at risk of opioid use disorder (OUD). For example, using federal funds available through the 21st Century Cures Act of 2016, the health system employs case management in their emergency department (ED). Patients with OUD who are brought to the ED due to an overdose are paired with a nurse practitioner who functions as a case manager. The nurse writes prescriptions for medication-assisted treatment (MAT), schedules follow-up visits for patients, and coordinates nonemergency medical transportation through a partnership with Lyft, says Joan Papp, MD, director of MetroHealth’s Office of Opioid Safety.
The health system also has reached into the local jails to care for inmates with OUD. With federal funding, MetroHealth provides MAT to inmates. Additionally, the health system staffs an alternative to incarceration project, which connects certain inmates to MAT and peer supports to help treat OUD. Navigators provide support in the courtroom, coordinate a post-release care plan, and ensure that inmates in need of OUD care are connected to services upon release, Papp says.
The University of Cincinnati (UC) and UC Health have convened an Opioid Task Force, an initiative that fosters collaboration across the university and health system by engaging with community partners and promoting opioid-related research, interprofessional training, education, and practice, says Candace Novak Sabers, UC Health’s vice president of government relations.
UC and UC Health have incorporated OUD education into the university’s colleges of medicine, nursing, allied health sciences, and pharmacy. With grant funding from the Substance Abuse and Mental Health Services Administration, the university offers an interprofessional training course to students in those colleges that focuses on screening, intervention, and referral to treatment. The university hopes to expand this course in the future to law and criminal justice students, Sabers says.
In addition to infusing opioid misuse into the academic curriculum, UC Health provides opioid-related clinical services to its diverse patient population. Since 2016, UC Health has targeted women with OUD through a Perinatal Addictions Clinic, which provides perinatal, addiction, and mental health services to more than 125 mothers and babies.
In the ED, UC Health recently piloted a program for a MAT pathway, which provides screening, MAT, addiction counseling, and early/next day entrance into recovery programs at the hospital or in the community, Sabers says. This pilot program also trains emergency care providers and has helped providers obtain the Drug Enforcement Administration waiver needed to dispense MAT.
The Ohio State University (OSU) Wexner Medical Center
The OSU Wexner Medical Center’s leadership has allocated funds to support the state’s response to the crisis, formed an Opiate Crisis Steering Committee, and established a management structure to coordinate efforts. The steering committee meets monthly to discuss opioid-related initiatives across the campus, says Brendan Mapes, assistant coordinator of opioid policy and research at OSU Wexner Medical Center.
On-the-ground initiatives include the Substance Abuse Treatment, Education, and Prenatal Prevention (STEPP) clinic through the Department of Obstetrics and Gynecology at OSU University Hospital. The weekly STEPP clinic serves pregnant people with substance use disorder and connects them to high-risk prenatal care, counseling, and MAT to help them get on the road to recovery.
Project Stay Strong, a College of Nursing initiative, aims to prevent opioid use through education. Online educational modules will provide information about the risks of opioid use, evidence-based approaches to managing stress and anxiety, alternatives to prescription pain management, and other topics to health care professionals, athletes, and those with OUD.
The HEALing Communities Study
Notably, OSU also is leading the way for interdisciplinary collaboration across the state. With a federal research grant from the National Institute on Drug Abuse, OSU is partnering with UC Health, other state universities, state agency leaders, and community organizations in the HEALing Communities Study (HCS) initiative. The HCS will facilitate sharing of best practices and implement proven approaches to prevent overdose deaths and achieve long-term solutions to OUD in 19 Ohio counties.
Mapes notes that the $65.9 million grant awarded earlier this year is the largest in OSU’s history. UC Health was awarded $15.1 million over four years for this initiative. The program’s ultimate goal is to reduce opioid-related overdose deaths by 40 percent over the next three years.
Project DAWN (Deaths Avoided With Naloxone)
Both MetroHealth and The OSU Wexner Medical Center participate in the Ohio Department of Health’s Project DAWN, the state’s network of opioid education and naloxone distribution programs. In addition to take-home naloxone kits, program participants receive training on how to recognize the various types of overdose, engage emergency medical services, and properly administer naloxone to an individual in crisis. Participants include individuals at risk for an opioid-related overdose and friends and family members of at-risk individuals.
The state first piloted Project DAWN in 2012, and MetroHealth began participating in 2013. The OSU Wexner Medical Center’s University Hospital and Ohio State East Emergency Departments became Project DAWN sites in early November, says Mapes.
These examples are not an exhaustive list; rather, they provide a glimpse into the efforts of essential hospitals in Ohio to curb the opioid crisis. Essential hospitals, in Ohio and across the country, continue to adapt to the needs of their patients and communities by identifying and applying comprehensive care approaches to better the health of their patients. Continued federal and state focus and support allow essential hospitals to provide innovative, critical health care services that put those affected by the opioid epidemic on the path to recovery.
Members of America’s Essential Hospitals can find more information about state-level developments on our State Action opioid resource page. The association also has a resource page for the federal response to the opioid epidemic and a tracker highlighting funding opportunities available to essential hospitals under the SUPPORT Act.