H&HN's Marty Stempniak spoke with Peter Holden, president and CEO of Beth Israel Deaconess Medical Center–Plymouth, about the cause of, roadblocks to and potential solutions for the opioid epidemic.
How did we get to this crisis point?
HOLDEN: When you have insurance companies that rate physicians and patient satisfaction on pain control, when you have the Joint Commission calling pain the fifth vital sign, and everything else over the past 10 years, I think that physicians have been somewhat tacitly encouraged to overprescribe opiate painkillers, and it’s just gotten to the point that it has ballooned in number. Consequently, those pills end up unused in medicine cabinets and, if you’re an addict, you find those pills. A lot of police departments have drop boxes for unused medications. Well, when we’re out in the community, we have heard from parents and others saying, ‘I don’t want to take the pills to the police department because I kind of feel like I’m putting a spotlight on my child.’ And so, we said to hell with that, we’ll put a box in the hospital. I found out that the Drug Enforcement Administration doesn’t allow it. So we talked to our congressman, and others talked to the DEA, changed the regulations, and we put a drug box down by one of our main entrances. In a month, we had collected over 40 gallons of unused meds. So, you open it up, it’s quite secure by the way, and you look at all these unnecessary bottles of narcotics, and it’s like, my God. The health care industry definitely has a role in abuse and has a role in fixing that abuse. We need to use more multimodal analgesics. There are very effective painkillers out there that are not opiates, and unfortunately, some of them are more expensive, but there are just far too many opiates on the street.
Any specific patient stories that stick out?
HOLDEN: There is a family that has six children, all having gone through the Plymouth school system. Some are athletes, some are academics, all are good kids. Five of them are addicted to opiates. Overdoses, auto accidents, Narcans, jail time, you name it. I know the parents and I’ve listened to the entire story, and I would like to think that I am a good parent. My wife and I have four teenage to young-20-year-old boys. So, we’re very attuned to this, and I listened to the parents’ story and I thought to myself, I would have done exactly what they did all along the way. People like to think, ‘Oh, I’m not that kind of parent. My kids aren’t those kinds of kids.’ That could not be further from the truth. This is disease, it is insidious, and unless we treat it like a disease, we are going to fail. Our behavioral health system in this country, at least in Massachusetts, has been woefully ignored and underfunded since we closed all the inpatient institutions back in the ’60s, and we have fallen further behind ever since. There is not sufficient treatment available for these people. Because we have this stigma about behavioral health and addictions, we are not paying as much attention to it, and it’s frightening. Fourteen-hundred people in Massachusetts died last year from opiate and heroin overdose; if you remember the national firestorm over Ebola, I know every life counts, but two people died. Two American citizens died in the Ebola crisis.
What have been the biggest hindrances to your progress in addressing this epidemic?
HOLDEN: Physical capacity. We are an acute care hospital and we are designed for acute care medicine. Right now, 25 percent of the patients who come into our emergency department have a behavioral health comorbidity and we’re just overloaded. That may be because of sheer volume of patients or the fact that our communities know that we are committed to dealing with this issue, so we’re getting patients who normally would have gone to other facilities. We are virtually in crisis mode and we are exploring other treatment avenues for taking care of these patients because the need is just daunting.
HOLDEN: Potentially opening up a behavioral health emergency facility. We are talking to some of our neighboring hospitals to see if there is the potential of a regional approach. We’re working with the courts. We’re working with the Plymouth County Corrections Facility to see if there is physical capacity in the community that we can take advantage of. Part of the problem here is that addicts have been treated as criminals, and they’re not. They’re patients. These people are sick and they need help, and so we treat them very compassionately and we try to help them get better. There is still that huge social stigma out there and we battle that every day. I think the insurance companies in the state are finally coming around to recognizing that it’s an illness and that they need to provide for these services and not deny access. That’s been a major problem. The last research I saw on insurance companies’ behavioral health payments is that the percentages of total medical expense were actually going down instead of going up. Given the crisis, that’s just amazing.