POLICY BRIEF: OPIOID CRISIS
To: Bill DeBlasio
From: Amber Shaikh
Date: 1/18/2020
Re: Preventing and Managing the spread of Opioid Overdose in America
Statement of issue: Opioid overdose refers to the misuse or overdose of prescription medication. Opioid substances are derived from the opium poppy plant, or any type of synthetic alternative similar to it. Medications containing opioid include: heroin, morphine, tramadol, oxycodone and methadone. Opioids have an addictive property, along with a high tolerance, making it easier to form a dependence to it. An issue of overdose happens when people are unable to counter its addictive properties and are not properly educated of its proper use. In 2017, the HHS declared the opioid epidemic a public health emergency. On average over 130 people die from opioid overdose every day, an epidemic that can be prevented and managed with proper education, treatment and regulations on prescription medications.
Epidemic by the numbers: As per a report by the US department of health and human services, over 130 people die every day from opioid related drug overdoses. Over 10.3 million people misused prescription opioid medications in 2018, and of those 2 million people developed an opioid drug overdose disorder and 47,600 people died from overdose. In 2018, it was found that 808,000 people used heroin, of those, 81,000 were first time users and 15,349 people died from heroin overdose. Finally, 32,656 deaths were caused by overdose of synthetic opioids, other than methadone.
- Unlike most other forms of addiction that are concentrated to certain areas and populations, opioid crisis is spread across all socioeconomic backgrounds.
- Whether its rural neighborhoods, or urban ones, the opioid crisis is widespread and has become a national crisis. Victims of opioid addiction are those of all ages, socioeconomic, ethnic and racial backgrounds. However, there is a slight majority that is affected more, due to the sheer medicinal characteristics of opioids. Opioids are used to treat pain, trauma and injury, and at times, depression and age related issues. For this reason, a Social Capital project in 2017 showed that most likely men and women who are white and in their mid 50s, without a college degree are a main target.
- Over the past few years, the number of opioid medications prescribed has increased significantly, and the policies and regulations set to prevent overdose has continued to be inconsistent.
- Since 1999, deaths due to opioid overdosed has quadrupled. This increase is due to overdose, misuse, over prescription, and illegal consumption. With this there is a dire need for stricter regulatory policies and increased patient education. High quality education by specialists is necessary to teach both the providers and patients about the harms of opioid misuse, in order to manage future crisis.
- Opioid medications come with their set of side effects, however opioid overdose side effects can be fatal.
- Known as the opioid overdose triad; the symptoms include: pinpoint pupils, unconsciousness, and respiratory depression leading to death. Combining opioids, alcohol and sedative medications can increase chances of respiratory depression and death.
Policy Options
- Health care workers are largely responsible for the spread of the opioid crisis in a way, for they have the access to these medications. Whether they are over prescribing or obtaining the medications illegally and distributing them, having a way to create a checks and balance system for the providers would greatly help prevent opioid overdose. Restricting and regulating access of these medications will help control who has the ability to distribute it. A policy appointing a charge nurse, or someone of higher authority other then a Physician, as the point person who has access to where the opioids are will help limit physician freedom of using and obtaining opioids when they want. This not only goes for Doctors, but also nurses and home health aids who steal opioids from their elderly patients for illegal sale. There can be a policy where the chosen worker would sign an integrity form or say an oath to proper use and dispensing of such drugs.
- Advantages: Having limited access to these medications controls the amount being dispersed. Having providers be under careful scrutiny of who needs these opioid medications, will have them look closer at other possible options. This will also act as a big brother role ensuring that no Provider “steals” or illegally obtains more medication that they need. By limiting access, home health aids or nursing room nurses will also have limited chances or stealing medications from their elderly patients.
- Disadvantages: Finding a point person to take this role would be difficult, for how can one honestly and accurately check the integrity of one person. Even if penalties are in place, those who have intentions can find loop holes. Also having one person in charge can lead to chaos when that one person is needed for different tasks. If a person is in dire justified need for opioid for life saving purposes, and that point person is not easily accessible, it can lead to fatal circumstances.
- A policy that mandates the creation and use of a online database system that checks how many opioid medications are being prescribed by each Doctor. This can be an extension of the I-STOP system that is already in place (Internet System for tracking Over prescribing). The I-STOP Is a method to monitor your patients opioid use on an online database, the prescription monitoring program (PMP). A method to create even more monitoring and check the providers, there can be an extension to this program that allows higher authorities to check how much opioids each provider prescribed and for what reason. This coupled with the system monitoring which patients have had what medication, could lead to a decrease in the numbers of opioid overdose.
- Advantages: This will create another layer to opioid monitoring leading to further checks on prescribing such medications. It will create a more organized way to check for who is prescribing these medications and for what reason. It will also enable those who are overprescribing to be identified an dealt with. It will cause more careful use of these addictive medication.
- Disadvantages: reliance on computerized databases can be faulty and create errors, leading to inaccurate reports. Also not all providers may use the system how it was intended, leading to false data. The implementation of this software, with constant updates and an IT team monitoring it will also be very costly. Also since the system is using the internet, it can be hacked at anytime, so careful monitoring for viruses and scammers is an added hassle.
- Creating Mandatory training programs for providers and healthcare workers on the proper use of opioid medications will also help manage this opioid crisis. This includes a seminar (either online or in person) that goes through its needs, side effects, and how to manage and cope with its addictive properties. As providers work for many years, it is a good idea to have a refresher course on the dangers of opioid containing medications, due to the extent of the problem. Since medications are usually dealt with many people before getting to the patient (the provider, pharmacist, nurse, etc), this program should be an annual practice that is mandatory for all health care workers.
- Advantages: This will create a more informed and educated health force, that can forward this learning to their patients in order to stress the importance of proper use when taking opioids. It will lessen their reliance on this medication and create a more sense of scrutiny when prescribing. It will also create a more educated public that is aware of possible side effects and harms of overdose.
- Disadvantages: Organizing a mandatory seminar for the large number of health offices/hospitals/healthcare workers can be costly. It also may create kickback from providers who believe that this is not necessary and is a waste of time. Not all healthcare workers may participate, so there needs to be a system of attendance or penalty if one does not participate. There is no way to ensure that the public will gain valuable information out of these programs that will be implemented in their practice. Taking a chance on a costly project that does not have certain results may not be a plausible use of energy.
- After medications are prescribed they must go through the Pharmacists in order to be dispersed. This creates a vital role for pharmacists, as the middle man between the provider, proper medication use, and the patient. Policy mandating patient education be mandatory by pharmacists while dispensing opioid medications will add another layer of patient knowledge that will hopefully manage the crisis. Educating and reviewing proper dosage, use, length of time, and side effects should be reviewed with patients prior to their check out.
- Advantages: This will create another level of security, allowing the patients to gain proper use. Often times, between doctors appointments and pharmacy visits, patients forget the vital information that was provided to them. With this policy, they will hear the instructions and warnings one more time, so that it is emphasized. Patients who are not literate, and cannot read the instructions off the label will benefit from this most of all, as they are getting clear instructions as to not cause any confusion and misuse. Time consuming
- Disadvantages: This will be a time consuming process, as pharmacists may not have the proper time aloted to educate each patient, especially if there are a lot of customers. A lot of pharmacists may also forget to do this protocol if they are in a rush or busy with something else. There is no way to enforce this mandate or check if it is being implemented.
Policy Recommendation:
Even though the opioid epidemic has caused nationwide concerns, the number of prescriptions for opioid based medication still remains high. It is estimated that over 130 people die from opioid overdose every single day. This can be due to numerous factors such as lack of education, misinformed patients and misuse, no regulatory system, and easy access among many others. For this we need to create strict mandates and regulation for increasing provider adherence to Evidence based prescribing practices. To improve this, in 2016 the CDC created a 12 step guideline for Prescribing Opioids for chronic pain. It creates a framework for proper use, that weighs the benefits and risks ratio of using opioid as the best possible treatment option. Its a set of quality improvement measures that are voluntary, to be used by health care workers to track their improvement. With this I believe the best policy to help manage this epidemic is to implement a database that monitors how much opioid medications are being prescribed by each provider. A form of this policy is in fact in place called the Prescription Drug Monitoring Program (PDMP). This program was started in NY several years ago, but has been updated constantly. It is a nationwide electronic database that tracts all controlled prescriptions. It gives healthcare authorities access to information about patient behavior, the provider that prescribed the medication, and doses and strengths. Even though this program is costly and comes with the risks of any online database (possibility of it being hacked, IT issues, chances of crashing, etc), the benefits it provides outweigh the risks. This is a promising policy due its universal use and access (with an authorization number), real time data input and updates, and its ability to be used as a public health tool that can be used by state health departments in order to create interventions to help manage this nationwide crisis.
Sources:
https://www.cdc.gov/ruralhealth/drug-overdose/policybrief.html
https://www.nehi.net/writable/publication_files/file/nehi_opioids_policy_brief_final.pdf
https://www.hhs.gov/opioids/prevention/safe-opioid-prescribing/index.htmlo
https://www.aha.org/bibliographylink-page/2018-09-28-treatment-options-opioid-use-disorders
https://www.hhs.gov/opioids/about-the-epidemic/index.html
https://www.who.int/substance_abuse/information-sheet/en/
https://www.cbsnews.com/news/amid-opioid-epidemic-report-finds-more-doctors-stealing-prescriptions/
https://www.health.ny.gov/professionals/narcotic/prescription_monitoring/
