The numbers are troubling. Drug overdoses are the leading cause of accidental death in the United States, with more than 47,000 such fatalities in 2014. Opioid addiction is driving this epidemic--of those 47,000 deaths, nearly 19,000 were related to prescription pain relievers and 10,600 were related to heroin,according to the American Society of Addiction Medicine (ASAM).
Stemming this tide of opioid misuse demands action from all who touch the lives of those affected by this disease--law enforcement professionals, legislators, healthcare providers, long-term addiction rehabilitation specialists, behavioral health experts, and friends and families. And hospitals and physicians are on the front lines of the battle.
Consider the following statistics from ASAM:
- In 2012, 259 million prescriptions were written for opioids, more than enough to give every American adult his or her own bottle of pills
- Four in five new heroin users started out misusing prescription painkillers; as a consequence, the rate of heroin overdose deaths nearly quadrupled from 2000 to 2013
It’s that second data point that suggests an opportunity for hospitals to proactively mitigate this crisis. Here in Maryland, where drug- and alcohol-related intoxication deaths jumped by 21 percent from 2013 to 2014 and substance abuse visits to emergency departments spiked by 46 percent from 2010 to 2014, all acute care hospitals adopted, in the fall of 2015, standardized opioid prescribing guidelines to be used in EDs.
The guidelines, developed by the Maryland Hospital Association and the Maryland Chapter of the American College of Emergency Physicians, were crafted to allow doctors the flexibility to prescribe opioids when medically necessary while encouraging practices that can reduce the risk of opioid addiction. The guidelines promote:
- Screening and patient education to help detect and treat conditions that can lead to misuse, and to safeguard patients against the development of those conditions
- Using existing tools like the state's electronic health information exchange and prescription drug monitoring program to allow healthcare providers to more effectively track potential misuse of opioids
- Standardizing prescribing practices to reduce unnecessary prescriptions (and the number of pills prescribed) to diminish misuse of opioids
Maryland is toward the middle of the pack nationally in the number of painkiller prescriptions per 100 people, with more than half of the states in the country having at least 82.2 such prescriptions per 100 people, according to the Centers for Disease Control and Prevention. Twenty percent of non-medical prescription painkiller users obtained the drugs via a prescription. Access to potentially addictive medication is high, and it’s growing.
That’s why hospitals have to do their part.
In addition to the 100 percent adoption rate for the ED prescribing guidelines, Maryland’s hospitals are now working to improve the state’s Prescription Drug Monitoring Program so that it can support expanded usage in a way that helps physicians, pharmacists and others obtain an accurate picture of any patient’s medication portfolio, according to the Maryland Hospital Association.
There’s federal attention for this crisis as well--President Barack Obama’s fiscal year 2017 budget request includes nearly $1.1 billion in new funding to address prescription opioid misuse and heroin use by expanding access to medication-assisted treatment and other addiction treatment providers over the next two years.
But the president’s proposal, along with the measures now underway in Maryland, are just pieces of a more complex social and medical puzzle. Hospitals, in their unique role as community resources and trusted institutions, will remain at the forefront of this battle until the direction of this national epidemic changes course.
Carmela Coyle is president and CEO of the Maryland Hospital Association