Over the past several years, opioid abuse has become a widespread and urgent public health concern in the United States, and essential hospitals are taking steps to prevent misuse and promote better prescription drug management.
Opioids are a group of drugs that includes heroin and prescription pain relievers, such as hydrocodone and oxycodone. As of 2014, 1.9 million Americans had a substance use disorder involving prescription pain relievers and 586,000 had a substance use disorder related to heroin. Opioid overdoses have quadrupled since 2000 and were the cause of more than 28,000 deaths in 2014. Currently, 44 people die from prescription opioid overdoses every day.
According to the Centers for Disease Control and Prevention (CDC), the amount of opioids prescribed in the United States nearly quadrupled between 1999 and 2013, even though there was no real change in reported amounts of pain. This has prompted providers and public health officials to look closely at prescribing practices to avoid excessive availability of lawful opioids, which account for a large portion of overall substance use disorders and provide a gateway to heroin abuse (four out of five heroin users report prior misuse of prescription painkillers).
Opioid abuse is a national problem, though certain states in the Northeast, Midwest, and South have seen particularly high rates of death and addiction related to the drugs. Massachusetts has had one of the sharpest increases in opioid overdose deaths in recent years, with an estimated rate of 19 opioid-related deaths per 100,000 people in 2014. Various government and public health agencies in Massachusetts have put forth plans to stem the growing problem by focusing on its driving forces. The governor’s administration partnered with the deans of Massachusetts’ four medical schools and the Massachusetts Medical Society to develop 10 core competencies on the prevention and management of prescription drug misuse in medical education. Two of the four medical schools involved are affiliated with members of America’s Essential Hospitals — University of Massachusetts Medical School (UMass Memorial Health Care) and Boston University Medical School (Boston Medical Center).
The competencies are divided into three basic domains of prevention: primary, secondary, and tertiary. The primary domain focuses on preventing prescription drug misuse through screening, evaluation and prevention. The secondary domain tackles treating patients at-risk for substance use disorders by engaging them in safe, informed, and patient-centered treatment planning. The tertiary domain covers management of substance use disorders as a chronic disease by eliminating stigma and building awareness of social determinants. Three thousand medical students in Massachusetts will be taught this three-tiered curriculum in an effort to better equip current and future health care providers to prevent and treat substance use disorders.
Meanwhile, in a study released last month, researchers at Temple University Hospital and Temple University Hospital-Episcopal Campus in Philadelphia found that implementing voluntary opioid prescribing guidelines in emergency departments (EDs) can reduce misuse of such drugs. The voluntary guidelines encouraged ED physicians to
- prescribe the least-addictive drugs whenever possible;
- avoid prescribing long-acting opioids; and
- avoid prescribing opioid refills and provide only enough medication for patients to use before a follow-up appointment.
When the guidelines were introduced, the rate of opioid prescribing at the two hospitals’ emergency departments fell from nearly 53 percent to about 30 percent. More than a year later, the rate remained at about 34 percent, according to the researchers. In a follow-up survey, all of the participating physicians supported the volunteer guidelines.
As the issue of opioid use and addiction continues to plague states across the country, other teaching hospitals and medical schools likely will follow suit in establishing more refined and deliberate prescribing practices.