Opioid Addiction Crisis
The Opioid Crisis has become a major dilemma in healthcare effecting all population groups.
With the ever growing Opioid addiction problem in the United States our hospital is facing many challenges. From mothers delivering babies to the adult patients addicted to pain killers this is a crisis that is effecting all types of patients. Has anyone had success in developing programs to help reduce this crisis. Are there new non-addictive ways to treat patient to help prevent people from becoming addicted to opioids?
Many states are passing legislation to help prevent and I would like to here if there are any success stories.
Paul,
Our GYN Oncology program has established a protocol that has now been implemented throughout our GYN surgery service which significantly reduces the amount of opioids that are prescribed post-operatively. It has been well -received by patients with greater than 90% of patients acknowledging that their post-op pain is being controlled, and satisfaction among patients with their post-operative management. We will soon be expanding the protocol into other surgical services. Manuscript preparation in now in process so that we may begin to share the details with others. I’ll make sure to provide you with that link as it becomes available.
I think you should read this weeks New England Journal Of Medicine and look North to the Canadian reponse to opioid-addiction
I have taken this upon myself that I don’t prescribe it after every surgical procedure. If I have any doubt or concern regarding the patient being a drug seeker, I go into our state website which will give me details about the patient’s prescriptions. This is very helpful. It takes time, but I personally take the effort to do it. It has to start with each one of us. I have patients who leave very upset because they did not get what they wanted , but that’s okay with me. There are a lot of other options.
It’s saddening to see in the news what is happening in San Francisco. I believe it starts with us healthcare providers to bring about this change and not be reckless in our style of prescribing.
Drug overdoses claimed 64,000 American lives in 2016 — more lives than the AIDS epidemic at its height and up 22 percent from just a year before. In Delaware, 308 people died from overdoses in 2016, compared to 228 in the previous year. The opioid epidemic is a major catastrophe hitting our community, according to Terry Horton, M.D., FACP, FASAM, chief of the Division of Addiction Medicine and associate physician leader of the Behavioral Health Service Line at Christiana Care Health System.
Dr. Horton says addiction is a brain disease. Like other diseases, medical science offers tools that can help. Christiana Care Health System is a national leader in identifying and implementing these tools. As Dr. Horton and his colleagues work to help patients in Delaware overcome their addiction, he also works to build understanding nationally about the nature of the problem and teaches others how to meet these challenges in their own communities.
Christiana Care is adapting to the ongoing opioid crisis in its hospitals and in the community. This work includes a groundbreaking opioid withdrawal clinical pathway —which screens hospital admissions to find people going through withdrawal and connects them with resources to overcome their addiction. It also includes efforts to reduce opioid prescription, increase access to care, enhance care for infants and families impacted by opioids and much more.
Christiana Care’s opioid withdrawal clinical pathway is a medical road map which helps the hospital care team to better identify patients at risk for opioid addiction and guide them into effective treatment. Today, almost all patients admitted to the hospital are screened for withdrawal and evaluated for buprenorphine and discharge to a community provider. The hospital is a reachable moment. With the right tools, methods and staff, we are able to help identify those with substance use disorders, engage them by addressing withdrawal and facilitate their transition to community-based treatment. Among the processes and tools of the clinical pathway is a simple screening tool developed at Christiana Care that consists of two questions:
• “Have you used heroin or prescription pain medicines other than prescribed in the last week?”
• “Do you get sick if you don’t use heroin, methadone or prescription pain medications?”
Patients who answer “yes” to either question are entered into the pathway and systematically evaluated using the Clinical Opiate Withdrawal Scale (COWS) to look for signs including restlessness, chills, flushing, tremors, runny nose, vomiting and diarrhea, which may indicate opioid withdrawal.
Additionally, Christiana Care Health System’s Project Engage is a rapidly expanding program that saves lives and money by engaging people with substance abuse problems at the hospital bedside and linking them with resources in the community that can put them on the path to wellness.
In the program, engagement specialists counsel patients and encourage them to go directly into treatment when they leave the hospital. Their mission is to remove barriers to care by arranging for placement in treatment programs, as well as such basic needs as food, clothing and shelter. If they need a ride to treatment, we will give them a bus pass — or drive them there.
The opioid crisis is an example of a harm reduction program failure in your country. Replacing a substance of abuse with another less potent but similarly acting substance is not a solution to the probIem specially knowing the biological issues in addiction (these substances actually cause adaptive changes in the brain neurochemistry leading to a defective satiety centre thereby causing cravings and urges). Recovery from addiction is truly a life long process just like in any chronic medical condition (diabetes, hypertension, heart disease, etc) if we don’t go for abstinence, we will not be able to allow the brain to recover from the adaptive changes that has occurred. As far as we are concerned, abstinence coupled with behavioural and family support programs is still the way to go in addictions treatment. The statistics in our program for the last 18 years has a cumulative data of 36% relapse rate after finishing a one year residential program and a lifetime aftercare program made available for free. We also believe that family support and involvement is very important in the process of recovery of the person with addiction that is why we run two programs – one for the person in recovery and the other for the family. I am not sure how the American family gets involved in the process other than allowing the person to just live his/her own life. Over the years, studies have shown that at least 50% of people with substance abuse problem also have a co-occurring psychiatric condition. This can never be ignored since it puts the person more at risk and the process of recovery becomes even more difficult.
We understand that opiate withdrawal is indeed very difficult hence the process of detoxification needs to be comprehensive and all symptoms controlled. They should not be immediately brought back to the community because of the high risk for relapse. Our cultural differences also makes it difficult for me to understand why it is only the right of the substance abuser that is being greatly considered in your programs. The families and the communities also have rights. While they are not the ones addicted, they are greatly affected by the problem. The families specially the children are put in situation of stress and distress, deprived of opportunities and of peaceful lives. The community also bears part of the burden because resources are being poured to this problem when it could be handled better. I am also distressed by what I have recently seen in the streets of New York (last week to be exact) – people slumped/lying on the streets evidently intoxicated and people just passing them by as if it were the most natural occurrence. Also, I have this thought that the programs in this country are highly influenced by what can be covered and not covered by the insurance and what the pharmaceutical companies would like us to believe.
The real crisis is a system allowing patients becoming addicts by medicin prescribed by doctors. There should be one doctor responsible for all opiods prescribed beyond e.g. 4 weeks. In some systems that would be the general practitioner og the family doctor. Is may be difficult sanitizing the medicine after a hospital stay, but if hospital doctors let the family doctor take care there would be a sense of temporality of opiod use. The system should detect and report to the authorities about long-term use and the doctor should be asked questions if prescribing opiods to non-malignant diseases beyond 4 weeks.
There should be clinics available for treating chronic pain focusing on non-medical approaches.
What about medical canabis? Is that goind to be the next crisis? The next opium fof the people? It’ll make you passive and forget about other problems in your life and in the society?