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Joy Daughtery Dickinson is executive editor of the Hospital Group of publications at AHC Media in Atlanta and long-time editor and writer of Same-Day Surgery. She has won nine national awards from the Specialized Information Publishers Association and the Association of Business Information & Media Companies for her blogging, news writing, and editing. She makes her home in southwest Georgia.
I’d never heard the F word use so many times in a one-hour time period.
I was at a Narcotics Anonymous meeting in a nearby town with a friend. I had taken her there in an attempt to help her get sober. Like many, her problem had started with legitimate prescriptions for chronic pain. The initial prescriptions ran out; the pain did not. She didn’t have a lot of difficulty getting more prescriptions. Before she knew it, she was addicted.
I found it difficult to find help for her. Information on the Internet was outdated. We later learned there was a NA meeting in our hometown. Such meetings can be a lifesaver. The people at the NA meeting we attended openly shared about their everyday struggles with addiction (hence, the frequent use of the F word). I don’t think I’ve ever seen a group of people so heartbreakingly honest.
Opioid addiction is hitting hospitals and healthcare providers across the country, as drug-seekers increasingly crowd EDs and physician offices looking for that next hit. Hospitals also are seeing increasingly numbers of patients who have suffered drug overdoses. In Florida, drug overdose deaths increased more than 80% between 2003 and 2009. Forty-four people die each day from prescription drug overdoses, according to the CDC.
Every state has responded. All states and the District of Columbia now monitor drug prescriptions. Also, at least 12 states regulate pain management clinics. The oversight seems to be helping. A just-released study shows that two Florida laws have made small, but still significant, decreases in how many opioids are prescribed. One of the laws tracks patient names, dates of prescriptions, and the amounts that are prescribed. The other law addresses “pill mills,” the pain clinics that traditionally have high numbers of opioid prescriptions. Under the new state law, they have to register and also be owned by a physician.
In just the first 12 months after these laws were implemented, the number of opioid prescriptions in Florida fell 1.4%. The number of opioids prescribed fell 2.5% when compared with Georgia, which didn’t have opioid monitoring in place at the time. While those numbers seem small, they equal 750,000 pills a month. The biggest declines were seen among the heaviest users and the largest prescribers. (For more information on this study, see the Aug. 17 issue of JAMA Internal Medicine.)
There is response at the federal level as well. This week, HHS held a two-day meeting with representatives from each state who focused on preventing opioid overdose and opioid use disorder. HHS announced it will revise regulations for prescribing of buprenorphine to treat opioid dependence. Also, HHS will give $1.8 million to rural communities to expand access to naloxone, which reserves an opioid overdose. (For more information on these drugs, see “Patients more likely to engage in treatment at 30 days when given buprenorphine in the ED, referred for follow-up” from the August issue of our ED Management publication.)
Hospitals must take note of this issue. There have been several cases of emergency physicians prescribing long-acting opioids that have led to deaths and malpractice lawsuits. (See “EPs Face Some Significant Legal Risks with Opioid Prescriptions” from the August issue of our ED Legal Letter publication.)
Policy changes help the address the issue. So does vigilance on the part of hospitals and providers. When we all work together, recovery becomes attainable. (Editor’s note: Follow us on Twitter @HospitalReport.)