In the last year, COVID-19 has dominated providers’ attention, adding additional layers to patient care in a system that already required many extra tasks. Let’s not forget that Delaware has another widespread medical crisis: the opioid epidemic.
Most of us can agree that the opioid epidemic has affected this country to its core. COVID-19 has only made it worse and increased the number of drug-related deaths seen nationwide and in our own state. Addiction and the stigma associated with it warrant an important discussion in the health care community and with our patients.
The latest statistics from the Centers for Disease Control and Prevention (CDC) are concerning. Delaware has the highest rate in the nation for prescribing high-dose, extended-release opioids. In Delaware, there are 9.8 and 11 of those prescriptions written per 100 people, respectively.
Equally concerning is that Delaware is ranked second in the nation for overdose deaths, according to the CDC. In 2018, 88% of Delaware’s 401 overdose deaths involved opioids, according to the National Institute on Drug Abuse (NIDA).
The opioid crisis in our state deserves the medical community’s full attention. As physicians, advanced practice providers and prescribers, we can play a significant role in improving these troubling statistics and, in doing so, prevent future opioid addictions and related deaths.
In many cases, opioid addiction and overdoses begin with a prescription. Millions of Americans who struggle with chronic pain are often prescribed an opioid, but those highly potent medications carry the risk of addiction and possible overdose.
Long term, opioid medications are not an effective solution or treatment for chronic pain because patients can become physically dependent upon them, requiring higher doses to achieve the same level of initial pain relief. For that reason, the CDC recommends that providers first consider nonopioid options for treating non-cancer-related pain.
As medical providers, we can also save lives and prevent drug misuse by checking Delaware’s Prescription Monitoring Program (PMP).
In some cases, fatal overdoses can be accidental. For example, older adults taking multiple prescriptions for chronic diseases are at increased risk for drug interactions, according to NIDA. Individuals who are taking benzodiazepines such as Xanax for anxiety should avoid taking opioid medications for pain because the combination suppresses breathing and can be fatal.
Checking the PMP has never been easier. This summer, the Delaware Division of Professional Regulation’s Office of Controlled Substances partnered with Appriss Health to offer providers and pharmacists the ability to integrate the PMP information into their normal workflow. Once providers set up alerts within a patient’s profile, they are notified of dangerous drug interactions and whether a patient was prescribed high-dose opioids. Providers can click on a link within a patient profile to see the entire PMP report for that individual, including risk scores and alerts. This allows all providers to quickly and clearly access important information to assist the clinical decision-making process, while avoiding serious repercussions for the patient. Providers and pharmacists can visit dpr.delaware.gov/boards/pmp and click on “PMP Integration Initiative” to apply for access to the system.
Providers can find other tools to help them make informed prescribing decisions on helpisherede.com, a well-organized website created by the Delaware Division of Public Health. Help is Here features best practices, resources and community information.
The site also features a variety of risk assessments, decision tree algorithms and a collated list of CDC, National Institutes of Health and other health guides.
I have not been a part of the Delaware health care community for long, having arrived in March 2020. Most of that time has been dedicated to the ongoing COVID-19 pandemic. However, during my military career, I saw firsthand the impact addiction had on people and their families, and I have carried that knowledge with me into my role as a leader physician.
Opioid misuse is something we can tackle together as one medical community. Safe prescribing should become common practice for Delaware providers. Let’s use these available resources.
Dr. David A. Tam, MBA, FACHE, is president and CEO of Beebe Healthcare, a community-based, not-for-profit health care system.
