23K opiate pills per person
Drug wholesalers shipped 9 million pain pills over two years to a single West Virginia pharmacy in a town of 392 people. It is unfathomable how that data could have gone unchecked. “The distributors knew what was going on. They just didn’t care,” Sam Suppa, a retired Charleston pharmacist, told the Charleston Gazette-Mail.
Opioid prescribing rates vary widely across the country. Providers in some states are found to write three times as many prescriptions per person as others.
“Prescription opioid overdose, abuse, and dependence carries high costs for American society, with an estimated total economic burden of $78.5 billion,” according to a recent study in Medical Care.
New York mayor Bill de Blasio blames the Pharma industry for his city’s rising death toll, “The pharmaceutical industry for years has encouraged the overuse of addictive painkillers and that has unfortunately poisoned our entire society.”
Deaths from opioid overdose
The above chart reflects deaths limited to prescription opioids. Non-methadone synthetics is a category dominated by illicit fentanyl, and increases the total deaths to more than 30,000 annually as reported by the National Institutes on Drug Abuse.
Prescribing patterns linked to patient addiction
New research reported in February 2017 from Harvard Medical School and T.H. Chan School of Public Health found emergency room patients were at greater risk for long-term opioid abuse if they were treated by physicians more likely to prescribe opioids. High prescribers treated 24 percent of their patients with opioids compared to lower frequency prescribers in the same emergency room who treated 7 percent of their patients with opioids for similar symptoms.
Researchers analyzed opioid use following an initial emergency department encounter, tracking more than 375,000 Medicare beneficiaries over 12 months. Data for more than 14,000 treating physicians was compared.
Patients could be at risk for abuse even after a single prescription.
The study also found that patients treated by the low frequency prescribers were no more likely to be readmitted for similar complaints.
Michael Barnett is an assistant professor at the Harvard T.H. Chan School of Public Health and reports in The Republic that standards are needed for opioid prescribing,
In contrast to medical conditions for which we have an abundance of data to guide the best treatment decisions, such as asthma or heart disease, pain treatment is often largely improvisational.
As a first-year trainee, you might observe a senior colleague prescribe 5 milligrams of oxycodone every six hours to someone with a severe ankle sprain. When you see the next patient with an ankle sprain, you will probably do the same. For low-risk situations, there is nothing inherently wrong with training by example. But with high-risk medications, our reliance on informal training could imperil public health.
Even where guidelines for pain management do exist, physicians’ adherence to them is exceedingly poor. Barnett says more formal opioid education in medical school and residency is needed, and physician competency in opioid prescribing needs to be continuously evaluated.
We need more data, interoperability of health care records to track prescription abusers, and better pain management studies to help combat this massive problem.Prescribing patterns linked to $78B opiate abuse problem. Click To Tweet
Drug diversion is now a healthcare organizational problem
The most common drugs diverted from the health care facility setting are opioids, according to a report by the Mayo Clinic. Healthcare providers may divert medications for personal use, for someone else, or for financial gain.
Because of easy access, anesthesiologists were found to have a higher rate of addiction to opioids than other physicians.
According to the Institute for Safe Medication Practices, “Drug diversion and abuse puts patients at risk for sub-optimal treatment from diluted or substituted medications, serious infections caused by contaminated needles and syringes, and errors committed by health professionals who are working while impaired.”
One in ten nurses is estimated to be impaired according to Thomas and Siela.
Some nurses may put thousands of patients at risk as they move from one state to another and hospital to hospital after their opiate abuse and thefts are uncovered. A report by NBC2 in southwest Florida found nurses caught stealing painkillers were still working in area hospitals.
While some chronic pain sufferers may indeed become dependent drug seekers in the emergency room, surgery patients face another dilemma. As they helplessly complain about their pain, their medicine may be unknowingly compromised. “Man up” is what nurse Sarah Casareto allegedly told a patient after stealing his medicine before he went under the knife and endured a kidney surgery from hell.
Mayo Clinic’s Dr. Keith Berge, a nationally known expert on drug diversion, says, “Every facility that houses these drugs has a problem. Everywhere these drugs touch, they corrode.”
DEA investigations in the past have focused on the individual’s role in drug diversion, but now hospitals, nursing homes, pharmacies and other organizations will be held accountable for a lack of oversight and diligence when diversion occurs, according to Deloitte.Opiate drug diversion in healthcare facilities is an organizational problem. Click To Tweet
Technologies to manage drug diversion
Omnicell Analytics is one web-based analytics tool for managing potential drug diversion across the health system. NARxCHECK is another analytics solution providing near real-time insights directly in the EHR to assist clinicians in prescribing decisions.
The Rudolph NDR is a system for distinguishing fentanyl from water in cases where medications may be substituted. It is sensitive enough to detect diversion of fentanyl even is less than ten percent of diversion has taken place.
AiCure uses artificial intelligence to confirm medication ingestion on any smartphone.Healthcare analytics for EHRs aimed at opiate abuse and drug diversion in healthcare… Click To Tweet
Proposed AHCA to cut addiction services
Treatment programs, however, are now more vulnerable than ever. According to the current version of the American Health Care Act proposed by the Republicans and backed by President Trump, there would no longer be a requirement to cover addiction services and mental health treatment under Medicaid in the 31 states that expanded the health care program.
According to Chuck Ingoglia, the senior vice president of Public Policy at the National Council for Behavioral Health, “We are really worried that this loss of protection and the financial pressure will force states to scale back.” Mental health groups are also voicing their concerns.Treatment for opiate drug abuse would no longer be covered by Medicaid in the proposed AHCA… Click To Tweet
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