- Opioid abuse is one of the most pressing population health issues in the US, especially among low income patients who are already at a higher risk for chronic diseases and often lack access to care. In an effort to stress the urgency of addressing the crisis, the White House has declared Prescription Opioid and Heroin Epidemic Awareness Week.
Opioid abuse kills more than 15,000 patients a year and impacts another two million Americans who abuse or depend on painkillers. Since 1999, prescription pain medication deaths in the US have quadrupled, and 44 people a day die from prescription opioid overdose, according to the office of the ONC.
"During Prescription Opioid and Heroin Epidemic Awareness Week, we pause to remember all those we have lost to opioid use disorder, we stand with the courageous individuals in recovery, and we recognize the importance of raising awareness of this epidemic," President Obama said in a statement.
The President is also using this week to stress action from Congress to provide an additional $1.1 billion in funding for treatment for prescription opioid and heroin abuse.
Despite no overall change in the amount of pain American reported, prescription opioid sales in the US nearly quadrupled from 1999 to 2014, according to the Centers for Disease Control and Prevention. During the same period, prescription overdose deaths also increased at a similar rate.
From 1999 to 2014, more than 165,000 Americans died from prescription opioid-related overdoses, the CDC says. Currently, at least half of all opioid overdose deaths involve a prescription opioid such as methadone, oxycontin, or Vicodin.
Prescription opioid abuse is also the strongest risk factor for starting heroin use. Approximately three out of four new heroin users say they abused prescription opioids in the past, the CDC says.
Since 2010, heroin-related overdose deaths have more than tripled. From 2013 to 2014 alone, heroin overdose deaths rates climbed 26 percent.
"One of the most significant ways to address these issues is to ensure that medical professionals receive adequate training on appropriate pain medication prescribing practices, and the risks associated with these medications," said President Obama in an October 2015 memorandum. "The Federal Government must do more to ensure that such training is provided on an ongoing basis to health care professionals prescribing pain medications."
According to a 2014 trend report from Express Scripts, nearly 60 percent of patients using opioids as pain medication are taking additional drugs that pose serious safety risks when taken in combination. Often times, these drugs are prescribed by multiple providers who may be unaware of additional medications and may have forgone adequate medication reconciliation.
More than two thirds of patients taking potentially deadly prescription drug combinations were prescribed the medications by two or more physicians. Nearly 40 percent of these prescriptions were filled at two or more different pharmacies.
As part of Prescription Opioid and Heroin Epidemic Awareness Week, the Department of Justice will be announcing funding to strengthen prescription drug monitoring programs (PDPMs) across the country.
The ONC created a resource page that highlights PDMPs as one of the main health IT tools that could help address the opioid crisis. PDMPs are centralized databases or online registries that detect prescribing abnormalities, track dispensing patterns, and aim to prevent patient access to dangerous amounts of opioids or other drugs.
Forty-nine out of fifty states have invested in these monitoring programs, but only sixteen states require prescribers to report to these databases when writing a prescription.
Using this type of electronic system "can be a highly effective tool in curbing abuse," the Express Scripts report said. However, the report also notes that collaboration between states, payers and benefit providers is necessary to obtain the necessary data and resources to identify abuse cases.
Research has suggested that big data analytics and monitoring programs increase provider awareness about potential patient misuse and abuse of opioids. Additionally, oversight of provider prescription habits may make clinicians more cautious about providing patients with controlled substances.
A recent Weill Cornell Medical College study reviewed PDMPs in 24 states from 2001 to 2010. Using National Ambulatory Medical Care Survey (NAMCS) data from that time period, researchers examined more than 26,000 ambulatory office visits for pain management and found 41 percent led to a pain medicine prescription. Five percent of those visits resulted in a Schedule II opioid prescription.
In instances where an electronic monitoring system had been implemented, researchers observed a 30 percent reduction in prescription rates for Schedule II opioids. Overall, the likelihood of a patient receiving opioid pain medication declined from 5.5 percent to 3.7 percent.
Another study by Geisinger Health System used big data analytics to develop profiles of patients who have overdosed on opioids. Researchers analyzed electronic health record data of more than 2000 overdose patients hospitalized between 2005 and 2015 and found mental health issues, prior drug abuse, or concurrent chronic conditions put patients at a much higher risk of harm or death from opioid abuse.
"Although we have made great strides in helping more Americans access care, far too many still lack appropriate, evidence-based treatment," Obama said in his statement. "This week, we reaffirm our commitment to raising awareness about this disease and supporting prevention and treatment programs."
"Let us ensure everyone with an opioid use disorder can embark on the road to recovery, and together, let us begin to turn the tide of this epidemic."