The opioid crisis has impacted the United States in countless ways: According to the U.S. Department of Health and Human Services (HHS), 70,630 people died from drug overdose in 2019 and in 2020, it was reported that 1.6 million people had an opioid use disorder in the previous year. Although there are many factors that contribute to this epidemic, physicians can have a positive impact by responsibly prescribing medications, identifying patients with opioid use disorders, initiating conversations, and more.
The Opioid Epidemic in New York State
In August 2022, the New York State Department of Health released an alert that warned the public of an “alarming” increase in opioid overdose in Central New York. “Cases of overdose are on the rise in Central New York, but we can make each overdose less likely to be fatal,” State Health Commissioner Dr. Mary T. Bassett said in the alert. She announced a statewide pharmacy standing order for naloxone, a medication that blocks the effects of opioids and allows individuals to regain consciousness and normal breathing. She encourages healthcare providers to obtain the drug and become familiar with its administration.
Identifying Patients with Opioid Use Disorders
The Medscape report “Physicians’ Views on Today’s Divisive Social Issues Report 2022” indicates that 42% of physicians see patients with a substance use disorder often in their practices. Although treating these patients is a complex issue, Medscape’s Jennifer Nelson explains that physicians can most effectively help these patients, as they are often the first to be aware of an individual’s substance abuse.
According to Nelson, some patients report that their physicians don’t seem interested in hearing about experiences with substance abuse. Nelson cites a nationwide study by researchers at Washington University School of Medicine in St. Louis: “80% of patients who met the diagnostic criteria for substance use disorder visited a doctor, hospital or clinic for some reason over the past year. Only 1 in 10 were encouraged to cut back on drinking or receive any form of treatment or referral for substance misuse.”
Because patients with substance abuse disorders may not feel comfortable discussing their condition, Nelson explains that the onus is on the physician to screen for issues. Starting these conversations may be tricky, but referring to resources such as the CAGE-AID Screening Tool may help. A simple question such as “Have you ever felt you ought to cut down on your drug use?” could be a useful conversation starter.
However, Nelson also points out that patient self-reporting may be “unreliable.” Therefore, experts recommend that physicians dive a little deeper into the conversation, gather history from family members or consider referring a patient for further evaluation.
The CDC’s Prescription Drug Monitoring Program (PDMP) can also provide physicians with valuable information about a patient’s drug history. The PDMP is a statewide electronic database that tracks controlled substance prescriptions and allows clinicians to learn more about patient drug history, such as the number of providers who are involved, medication amounts and other prescriptions that may increase risk. The CDC recommends checking this database at least once every three months and prior to every opioid prescription.
Managing Drug-Seeking Patients
When physicians are confronted by patients who are seeking drugs for inappropriate reasons, MLMIC recommends physicians take several actions, such as:
- thoroughly reviewing the patient’s medical history, conducting a physical examination and documenting all signs and symptoms of pain;
- exercising caution when dealing with patients who are not willing to have a physical exam, release medical records or demand an immediate prescription;
- documenting trial of a non-narcotic medication or therapy before prescribing a controlled substance;
- consulting New York’s I-Stop Registry prior to prescribing any Schedule II, III or IV controlled substances; and
- documenting the patient’s informed consent for treatment of chronic pain with controlled substances.
We encourage physicians to review the full Risk Management Tip on “Managing Drug Seeking Patients.”
Preventing Opioid Misuse
Physicians play an important role in not only addressing substance abuse when they see it, but also preventing it from occurring in the first place.
In a previous blog post, MLMIC highlighted that non-opioid alternatives have been shown to effectively manage post-surgical pain. Patient Engagement HIT’s Sara Heath analyzed a Michigan-wide registry documenting patient care practices after surgical procedures that took place in 2019 and found that although most of the post-operative study participants received opioid prescriptions, there were no significant differences in the clinical outcomes or experiences between individuals who received narcotics and those who received over-the-counter NSAIDS.
MLMIC has also examined the benefits of individualized opioid intervention and research suggests that personalized opioid intervention before discharge from the hospital can reduce opioid intake while still effectively managing pain.
Although addressing opioid misuse is a complex issue, physicians can help move the needle by initiating patient conversations, conducting screenings and considering preventive measures.
As part of our ongoing efforts to provide information to our policyholders on strategies that address opioid use, we offer a number of additional resources on the issue: