Revisiting The Opioid Epidemic and its Unintentional Consequences

drug overdose death rates in US

Source: Centers for Disease Control and Prevention

PHILADELPHIA—Americans represent 4.6% of the world’s population, yet we consume more than 97% of all the hydrocodone produced worldwide. In 2012, the CDC reported health care providers wrote 259 million prescriptions for painkillers, which is enough for every American adult to have a bottle of pills.

The Center for Public Health Initiatives dedicated a week in November to focus on the opioid epidemic and how to reduce the level of prescribing these drugs. In her talk, “From the Streets to the ER,” Dr. Jeanmarie Perrone from the University of Pennsylvania’s Department of Emergency Medicine proposed that health care providers should begin to focus on patient education, “It takes 30 seconds to prescribe and 30 minutes to educate.” So which one is a more viable option?

The fine line between compassionate pain management and encouraging addiction is often hard to distinguish when prescribing opioid medications. Larger patient loads and shorter doctor-patient visits (average, 7-9 minutes) may encourage physicians to prescribe chronic non-cancer patients opioids instead of spending time to educate them on alternative options.

Is the solution to the opioid epidemic as simple as a half hour of education? A team approach to patient education has consistently worked well. Dr. Perrone and her colleagues conducted a study involving two urban emergency departments in Philadelphia and investigated the use of a multidisciplinary team approach to decrease the amount of opioid packs dispensed at discharge. The interventions included educating a multidisciplinary team of nurses, residents, nurse practitioners, and attending physicians. The number of opioids dispensed at discharge for individuals who were at risk for opioid dependence decreased significantly from 21.8% to 13.9% in the primary ER investigated.

Studies involving a multidisciplinary approach and state regulations implementing prescription drug monitoring programs led to a successful reduction in rates of opioid abuse.

State Successes After Implementing Prescription Drug Monitoring Programs

Sources: NY, TN: DMP Center of Excellence at Brandeis University, 2014. FL: Vital Signs Morbidity and Mortality Weekly Report, July 1, 2014.

Sources: NY, TN: DMP Center of Excellence at Brandeis University, 2014. FL: Vital Signs Morbidity and Mortality Weekly Report, July 1, 2014.

Unintentional Consequences

With strong policies that have made it more difficult to obtain prescription pills, some argue that these regulations have only shifted the type of opioids being used.

Emerging research shows that the increased opioid regulations may be linked to the increase in heroin use. Over the past three years, opioid related fatalities in New York City have leveled off, while deaths involving heroin use have increased by 44%.

unintentional overdose deaths

As opioid regulations increase across the nation, public health practitioners should pay close attention to an unintended rise in heroin use, particularly in areas where heroin is readily accessible.

Written by: Amy Rajan, RN, MSN/MPH Candidate, Class of 2016

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