Opioids’ rising death toll demands comprehensive policy solutions

Marianne Udow-Phillips, left, is director of the Center for Healthcare Research & Transformation in Ann Arbor, where Theresa R.F. Dreyer is a healthcare analyst.

 

Opioid use is much in the news these days: no surprise, given the exponential increase in opioid prescriptions during the past two decades. Nationally, there were 76 million prescriptions for opioids in 1999. By 2011, that number had increased to 219 million, a nearly 200 percent increase. Similarly, deaths from opioid use have exponentially increased. In Michigan, accidental overdose deaths from opioids (both prescription and nonprescription) increased by nearly 550 percent between 1999 and 2013, rising to 519 in 2013 from 81 in 1999.

Communities across the state and country are struggling with how to stem the tide of opioid-related deaths. In Washtenaw County, an interdisciplinary group including law enforcement, mental health professionals, emergency medical professionals, patient advocates and others formed under the auspices of the Washtenaw Health Initiative, to reduce opioid deaths in the county.

The group has worked together to implement Project Lazarus, a national model that helps communities prevent drug overdose deaths while ensuring that those with chronic pain get the treatment they need. In summer 2015, this WHI-sponsored initiative helped train and equip local law enforcement officers with naloxone, an overdose reversal drug, resulting in six saved lives between August and November.

Projects like the one in Washtenaw County are incredibly important: they focus on saving lives when an accidental overdose has occurred. To fully address the problem, however, there must also be a focus on prevention of overuse of opioids.

Some who suffer from chronic pain are worried that the intense press and policy interest in opioid use and abuse will mean that state and federal policies will be introduced to limit legitimate opioid prescribing for pain treatment.

Treatment of chronic pain is complex. According to the U.S. Interagency Task Force on Pain, 100 million people in the United States suffer from chronic pain. The national task force grew from a 2011 Institute of Medicine report that called for the development of a comprehensive strategy to deal with the treatment of pain.

The task force recommended a multimodal strategy, including team-based care that includes drug and non-drug interventions such as cognitive behavioral therapy. But even with these comprehensive approaches, opioid use is often a component of a treatment strategy. It is essential that whatever policies are implemented to help reduce overuse of opioids do not impede the care of those who suffer from chronic pain.

Something patient advocates, clinicians, and law enforcement can absolutely agree on is that care for patients with chronic pain should be coordinated between the multiple practitioners who may see a patient with pain. Too often, however, that care is not coordinated.

In a study by the Center for Healthcare Research and Transformation, we identified 600 patients in our study population who had received at least 10 opioid prescriptions from 4 or more providers within 3 months. While these patients represented a small percentage of all patients who received opioid prescriptions, they are clearly the ones most at risk of harm.

Recognizing the growing concerns about opioid abuse, Governor Snyder convened the Michigan Prescription Drug and Opioid Abuse Task Force in summer 2015. The Task Force released its report – and accompanying recommendations – last October.

The task force recommended several actions that will address issues related to patient safety and uncoordinated opioid prescribing, including more provider and consumer education and, importantly, improving and mandating that physicians and pharmacists use the state’s database of controlled substances prescribing.

Some of these recommendations may be controversial, but if we are going to prevent more deaths in Michigan from opioids, better coordination of patient care is essential. The recommendations of the state task force would get us a long way to that goal.