There's an opioid epidemic going on right now, and your hospital can either get ahead of the problem, or wait until it shows up in your emergency department.
Of course, this is nothing new. But the epidemic seems all the more profound with last week's death of Academy Award-winning actor Philip Seymour Hoffman. Reportedly, after years of sobriety, Hoffman developed a reliance on prescription pills that spiraled into a relapse of heroin use. Such instances are growing in frequency, and the Centers for Medicare & Medicaid Services recently took note of the trend. A rule proposed by CMS last month would impose stricter guidelines for docs, punishable by the revocation of their enrollment in Medicare for overprescribing opioids and other drugs. (For more on overprescribing, you can also check out Emily Friedman's provocative piece from last week's H&HN Daily).
But, is taking caution with prescribing painkillers and treating overdose victims in the ED really where a hospital's role ends during this epidemic? In this new era of treating the health of populations, catching chronic diseases before they become acute, and integrating behavioral and mental health with all other forms of care, some experts say hospitals should travel further upstream.
At Rutland Regional Medical Center in Vermont — where the governor recently dedicated his state of the state address to the topic of heroin and opiate abuse — they've taken this mindset to heart. There, with the help of a state grant, the medical center opened a dedicated opiate treatment facility in downtown Rutland that's seeing 10 to 15 patients a week, CEO Thomas Huebner told me in a phone interview.
"Hospitals are, in general, changing how they view themselves in the world," he says. "A lot of us see ourselves not just as places that fix people who are broken, but more central to our communities in trying to keep them healthier. If you have that point of view, this becomes more natural."
One of the biggest challenges that a hospital can overcome in trying to tackle opioid addiction is stigma, Huebner says. Rutland Regional had been contemplating opening such a clinic years ago, but the community wasn't ready to face the problem head-on. Gaining support from clinical leadership, his board, and key figures in the community such as police and schools all proved essential.
Akikur Mohammad, M.D. — an addiction expert, psychiatrist, treatment center CEO and associate professor at USC's Keck School of Medicine — says sometimes it's necessary to educate clinicians to help them break their perceptions about heroin use. Some of the common misperceptions include that heroin is expensive and hard to obtain (false), that addicts can easily kick the habit if they so desired (false), and that there is no effective treatment of heroin (false). "There is not much knowledge and there is significant stigma, even within the medical community," he says.
What do you think? How large has your hospital's role been in trying to treat the opioid epidemic? How large of a responsibility do you think a hospital shoulders in this fight? Share your thoughts in the comment section below, and watch for more on this topic in the March issue of H&HN.