The opiate crisis is not over
Editor’s Note: This is the sixth blog post in a series in which Leigh Burchell shares the lessons learned from conversations with industry thought leaders during the Virtual ACE Conference Oct 6-8. Watch “Opioid crisis: Where are we, what’s next?” here.
Following are some key points from the conversation I had with Dr. Yngvild Olsen (watch the full recording here), an addiction medicine specialist from Baltimore, MD, who spoke not only about the latest statistics reflecting the nation’s crisis with opioid use disorder but what Allscripts clients can do to help their patients.
Many healthcare professionals have in recent years become aware of the crisis associated with opioid and opiate addiction, and looking back, it’s clear there were three waves of the challenge that brought us to where we are today, facing staggering volumes of lives lost every year.
According to Dr. Olsen, after several years of high-profile attention from the media and policy makers alike, many experts were pleased to see the rate of opiate-related overdose deaths related to prescriptions decline in 2018, with the opiate prescribing rate dropping to its lowest rates in 13 years. That gave substance use disorder specialists and others who frequently prescribe controlled substances, such a primary care specialists, dentists and surgeons, a glimmer of hope that the crisis was going to abate, but unfortunately, that decrease was a blip.
Even before COVID-19 hit the United States, the numbers started to trend upwards again in 2019, and unfortunately, the pandemic has increased the volumes of patients presenting with opioid use disorder or even, sadly, overdose.
One factor tying the pandemic to higher numbers of affected patients is, as Dr. Olsen pointed out, that patients with one use disorder are likely to be inclined to have (or in fact already have) another. The pandemic has unfortunately caused many people to turn to substances such as alcohol, marijuana and other drugs in reaction to the challenges of the past several months. Clinicians should be careful not to overlook the risk that a patient who shows signs of alcoholism might have problems with other substances later.
Relatedly, in considering how best to address substance use disorder in a physician practice or hospital, focusing on social determinants is an important step. Clinicians who make sure they are aware of stressors in their patients’ lives, such as housing insecurity, job loss or difficulty accessing food, may in turn more effectively identify when patients are at risk of dangerous drug use.
Another critical factor affecting people with addiction and their access to or willingness to participate in treatment for substance use disorder is stigma. Johns Hopkins University produced a study demonstrating that higher stigma toward people with opioid use disorder correlates to lower support for public health-oriented policies like Naloxone access, Good Samaritan laws or increased government spending on treatment options. Recognizing that substance use disorder is one of the brain – a medical issue – and not a moral failing can have measurable impact on the success of the patient’s treatment.
Dr. Olsen recommended several steps to consider going forward:
- Engage people suffering from substance use disorder through a variety of services, remembering to consider the needs of your patient base when evaluating the options you offer. Is telehealth a good fit? Have you evaluated your care efficacy with that modality? Do you have patients who don’t have access to broadband and are best consulted by phone?
- Address stigma associated with addiction – this can be a factor within the patient’s family, and it’s something that could affect your organization. Health providers can hold implicit biases, too.
- Maximize the technologies that are available. Are you making the most of all the information in your state’s prescription drug monitoring program (PDMP)? Also, consider running population analysis to determine whether there are patients in your care who might be showing signs of substance use disorder; if so, consider an opioid tapering plan in partnership with those patients. And are you going to be ready for the national requirement for ePrescribing of Controlled Substances?
- Check to see if your prescribing patterns reflect the risks of prescribing opiates – are you prescribing more days of opiate/opioid medications than your patient might need? What alerts might be relevant within your workflow to ensure that you are considering all viable paths for pain management?
- Pay attention to policy changes associated with patient privacy in this area, given Congressional action to ensure that behavioral health data can be considered part of and incorporated into the patient’s electronic record.