Prescribers Have Contributed to Opioid Epidemic but Can Help Stop It
Ohio is home to Dayton’s Montgomery County, a place that has reported the highest rate of overdose deaths in the United States. Ohio was second only to West Virginia in its overall rate of deaths from overdoses in 2017, according to the CDC.1 Much of Ohio’s overdose deaths involve fentanyl, and most of those are for prescription drugs.2
Also, according to the 2017 Ohio Automated Rx Reporting System, 80% of Ohioans who died of a drug overdose in 2016 had a history of receiving prescriptions for controlled substances.3 The Ohio Hospital Association, with a new $530,000 grant from the Cardinal Health Foundation, has begun to tackle the opioid epidemic with an initiative to collect benchmark data on opioid prescribing habits in pain management.
“We’re looking at what’s occurring from overdoses and mortality types of situations because it’s having a huge toll on Ohio communities and families,” says John Palmer, director of media and public relations for the Ohio Hospital Association (OHA). “In 2016, hospitals were managing 27,377 total overdose encounters, a 52% increase over 2015, and it was a 52% jump from just a year before. When you go [back] to 2008, it [has increased] 500%.” More than 70,000 people died from drug overdoses (47,600 from opioids) in the United States in 2017, a rate of death that was more than double the rate in 2016. The authors of a new study4 using county-by-county data from the CDC and other sources found that pharmaceutical company marketing of opioid products to physicians resulted in increased opioid prescribing and higher overdose mortality. In all, nonresearch-based opioid marketing totaled nearly $40 million, targeting 67,507 physicians in 2,208 U.S. counties.
Investigators found that there was a greater proportion of opioid-related deaths in counties in which opioid pharmaceutical representatives more frequently contacted physicians. One in 12 U.S. doctors received opioid-related marketing between 2013 and 2015, and one in five family physicians received the same marketing. Among Medicare patients, this marketing is associated with increased opioid prescriptions.
Efforts like the OHA’s opioid prescribing initiative will give doctors information about the dangers of opioid addiction, overdoses, and over-prescribing. OHA launched its opioid initiative after reviewing 2017 data on opioid overdoses and deaths.
“We went to work creating this opioid initiative, working with hospital members, some on the clinical side and some on the community/administrative side of the hospital,” Palmer says. “We listened to what they were seeing and encountering and what they perceived as prevention.”
The group has collected prescribing data and examines what hospital EDs are encountering regionally and statewide. “We look at trends and patterns and will do data collection and analysis, and then we’ll report back to the hospitals to address this,” Palmer explains. So far, about 70 hospitals have committed to participate out of the state’s 270 hospitals.
“We’re continuing to get interest to participate in that effort,” Palmer reports. “Cooperation will be critical. We’ll collect data to build effective solutions to change practices, as appropriate.”
The partnership with Cardinal Health Foundation will build on Cardinal Health’s opioid action program and Generation Rx. Opioid-sparing efforts and national attention on the opioid epidemic’s death toll already have affected prescribing habits in Ohio. For instance, the 2017 Ohio Automated Rx Reporting System’s annual report shows that the total doses of opioids dispensed to Ohio patients decreased by 28.4% (225 million doses) from 2012 to 2017. The report’s authors also found that doctor-shopping behavior plummeted by 88% from 2011 to 2017, a decrease from 2,205 individuals in 2011 to 273 individuals in 2017.3
Once developed, Palmer says Ohio’s opioid-sparing initiative’s best practices will be shared nationally with any states and providers interested in the information.
- Centers for Disease Control and Prevention. Drug Overdose Deaths. Available at: . Accessed Jan. 23, 2019.
- Daniulaityte R, Juhascik MP, Strayer KE, et al. Overdose deaths related to fentanyl and its analogs - Ohio, January-February 2017. MMWR Morb Mortal Wkly Rep 2017;66:904-908.
- Ohio Automated Rx Reporting System. 2017 Annual Report. Available at: . Accessed Jan. 23, 2019.
- Hadland SE, Rivera-Aguirre A, Marshall BDL, Cerdá M. Association of pharmaceutical industry marketing of opioid products with mortality from opioid-related overdoses. JAMA Netw Open 2019; Jan 4;2:e186007. doi: 10.1001/jamanetworkopen.2018.6007.
Ohio's opioid prescribing initiative could serve as a blueprint for others looking to give doctors information about the dangers of opioid addiction, overdoses, and over-prescribing.
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