Back The Opioid Epidemic: Where Are We Now?

The Opioid Epidemic: Where Are We Now?

By Debra Wood, RN, contributor

Although progress has occurred in decreasing the number of people dying from opioid overdoses, some troubling information indicates opioid deaths could be on the upswing again. 

“The national trend has shown a decrease,” said Asif Ilyas, MD, MBA, FACS, FAAOS, president of the Rothman Orthopaedic Institute Foundation for Opioid Research & Education and professor of orthopaedic surgery at the Rothman Institute at Thomas Jefferson University in Philadelphia. “The public, physicians and government combined have made a strong dent in opioid abuse in America.” 

The Centers for Disease Control and Prevention report that opioid-related death rates decreased by 2 percent from 2017 to 2018, the most recent federal data available. Death rates associated with prescription opioids declined 13.5 percent, but synthetic opioid deaths increased by 10 percent. 

Cynthia A Bill, LCSW, CRADC, CCTP-II, an addiction therapist at Timberline Knolls in Lemont, Illinois, said, “Opioids are still very much a problem in our country, and people are still having their lives ruined or lost.”

Attorney Harry Nelson, author of The United States of Opioids: A Prescription for Liberating a Nation in Pain, agreed stating that while short-term data, collected before COVID-19, showed improvement in opioid deaths, which he attributed to widespread dissemination of naloxone (Narcan), “long-term indicators show an increase in opioid abuse, and it will get worse.”

2020 statistics on the opioid epidemic

The American Medical Association (AMA) released an issue brief in May 2020 reporting increases in opioid-associated overdoses as the COVID-19 pandemic persists. It stated that more than 20 states have noted the rise in opioid-associated deaths.

Nelson reported a strong linkage between unemployment and opioid deaths. 

“The broad picture is pretty grim,” said Nelson. 

Rothman Orthopaedic Institute Foundation follows opioid deaths in Pennsylvania. Ilyas reported seeing a spike in multiple counties this year. The foundation predicts a 10 percent to 25 percent increase in opioid-related deaths over last year.

The COVID-19 deaths and pandemic are a concern, because of the obvious source of potential causative factors, Ilyas said. People are carrying financial and social strains, and access to normal resources have been compromised. People are not pursing preventive and maintenance healthcare due to fears of the coronavirus. 

“We need to make sure the policies we are pursuing to battle the pandemic are not so broad and blunt to cause collateral damage to finances, careers, jobs and education,” said Ilyas, suggesting a more surgical approach, with counties with minimal COVID-19, able to return to normal activities.  

Successful actions

Several initiatives have contributed to a decline in opioid-related deaths, said Ilyas, reporting a greater public awareness of opioid risks, prescribers pursuing more informed and multimodal pain management strategies, using of prescription drug monitoring programs and requiring electronic prescriptions for opioid medications. 

Prescription drug monitoring programs are electronic databases which track prescriptions for certain drugs. Prescribers check the database for their patients’ history of using certain controlled substances before prescribing an opioid. The CDC considers the programs a promising intervention in addressing the opioid epidemic.

Nearly 2 million healthcare professionals were registered to use their state’s monitoring program in 2019, and posed 460 million queries, according to AMA.

Greater availability of naloxone. First responders now, typically, carry it. All U.S. states and the District of Columbia have expanded access to the drug, which can reverse an overdose. Therefore, patients and family members can have access to the potentially life-saving drug. 

“Naloxone was approved for opioid overdose reversal nearly 50 years ago, and it took quite a long time for the overdose prevention movement to arise,” said Nancy Campbell, a professor at Rensselaer Polytechnic Institute in Troy, New York, and author of OD: Naloxone and the Politics of Overdose. “Overdose prevention has become the unlikely object of a social movement, powered by a miracle drug that helped shift law, policy, medicine, and science towards harm reduction.”

Increased access to mental health care may help. The AMA opioid task force recommends eliminating barriers to medication-assisted treatment for opioid use disorder and treatment for co-occurring mental health disorders. 

“Mental health services are a mainstay,” Ilyas said. 

All prescribers play a role

Better education of healthcare prescribers has contributed to reduced opioid prescribing, Ilyas said.

That includes locum tenens. When it comes to locums and the opioid epidemic, providers must be familiar with state regulations and health-system specific rules in regard to prescribing opioids and medication management of opioid use disorder—particularly those working in addiction medicine positions.

Nurse practitioners and physician assistants also can contribute to reduced opioid prescribing and treating patients with opioid use disorder.

“The whole healthcare team will play a pivotal role in caring for the increasing load of patients with opioid use disorder,” said Brian W. Wu, PhD, MD. “Only through cohesive collaboration can we expect to begin to change the national trends.”

Nelson indicated that he does not think physicians are the problem. For them, “it’s a lose–lose proposition,” because of the chronic pain epidemic and no objective criteria to measure that pain.

“Physicians are being blamed for a deeper societal problem driven by pharmaceutical misconduct,” Nelson said.

Related:
5 Ways Prescribers Can Fight the Misuse of Prescription Drugs

The Latest Opioid Prescribing Guidelines for Hospitalists


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