The state of Maryland also has been a leader in the field. Leana Wen, M.D., the Baltimore city health commissioner, told a Congressional hearing in December of last year that she has declared an opioid overdose public health emergency and has issued a standing order that pharmacists can provide naloxone without a prescription to any person trained in its use. As she told me in an interview, “From our standpoint, there are three pillars to saving lives: First, getting naloxone into the hands of everyone who has the opportunity to save a life, which includes not only first responders, but also friends and family. Second, providers must be judicious in prescribing opioids. Third, the public must be educated about opioid addiction.”
The Baltimore City Health Department so far has trained more than 7,000 people in the use of naloxone, as Wen says, “In jails, public housing, bus shelters, street corners and markets.” The department also has worked to prevent deaths from heroin laced with fentanyl, which killed 39 people in Baltimore in a three-month period last year. That happy product is apparently coming from China and is appearing in many urban areas.
There are those who say that it doesn’t matter what happens to addicts. It matters to me; I spent years counseling Vietnam War veterans who came back with addictions. People end up in that situation for many reasons and I, for one, will not judge them. I just don’t think addiction should be a death sentence. We spend a lot of time yammering about how all life is sacred; we should walk the walk.
This issue is starting to have legs, as it were, and many other states are initiating their own efforts. The North Carolina Harm Reduction Coalition is making naloxone, along with condoms and clean syringes, available to people who are at risk. There has been a 50 percent reduction in heroin overdose deaths as a result. Surrounding counties and neighboring states are starting to emulate this model.
The state of West Virginia has sued pharmaceutical drug distributors whom it says looked the other way when it came to high-volume purchasers and prescribers of opioids. Blue Cross Blue Shield of Massachusetts has launched a comprehensive opioid safety management program that includes prohibiting opioid purchases by mail, limits on the amount of drugs allowed per patient per day, and outlier reports on individual and group medical practices.
Florida has increased regulation of pain clinics — some of which are nothing more than pill mills — and has prevented physicians from dispensing painkillers from their offices. As of 2012, there has been a 50 percent decrease in overdose deaths from oxycodone in that state.
Tennessee requires all prescribers to check the PDMP database before writing a prescription for painkillers, and has seen a 36 percent drop in doctor-shopping. Colorado has developed a comprehensive plan that includes stronger surveillance of prescribing practices, public education, expanded access to naloxone and “increasing the voice of those who are affected by the epidemic,” in the words of Robert Valuck, Ph.D., professor of clinical pharmacy at the University of Colorado, testifying before Congress in December.
What Providers Can Do
So there’s a lot being done, sometimes very creatively. But in the end, this problem begins with providers. Most prescription drugs are made available by the health care system, so it is our responsibility to see that they are used appropriately. Is that always possible? Of course not. Many rogue prescribers do not have hospital privileges and are, therefore, out of the reach of hospital or health system medical or nursing staffs. Some state and county medical and nursing societies are very serious about addressing the problem; others, not so much. Some state boards exercise excellent oversight; others don’t.
We can’t rely on other entities in this case. The buck stops with health care providers. The CDC offers this guidance:
· Follow best practices for responsible painkiller prescribing to reduce opioid painkiller addiction, [which is] the strongest risk factor for heroin addiction.
· Use prescription drug monitoring programs and ask patients about past or current drug and alcohol use prior to considering opioid treatment.
· Prescribe the lowest effective dose and only the quantity needed for each patient.
· Link patients who have substance-abuse disorders to effective substance-abuse treatment services.
· Support the Food and Drug Administration-approved options (methadone, buprenorphine, naltrexone) for patients addicted to prescription opioid painkillers or heroin.
Our health care system did not start this, although it has played a major role in it. But we can help to end it. Let’s do so.
Copyright © 2016 by Emily Friedman. All rights reserved.