Thursday September 21st 2017

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Tracking Drug Overdoses May Save Lives

New Ideas to Help Overdosing Drug Addicts

America continues to struggle with the opiate crisis and is searching for ways to resolve it. It is a daily battle that will only be conquered by implementing gradual changes for all involved. How might tracking systems help?

In this article, we’ll explore emergency room reports and how they might be tracked to help people who overdose on drugs. Plus, we look into innovative ideas just being implemented in ERs in certain states and counties across the States.

Finally, we invite your comments and feedback. Please comment at the end. We’ll do our best to respond to each comment personally and promptly.

The Numbers

Drug overdose is the leading cause of accidental death in the United States, surpassing car accidents and gun violence. According to the CDC (Centers for Disease Control and Prevention),

91 Americans die every day from an opioid overdose.

This astounding fact is made more serious in knowing that the number of daily overdose deaths would be significantly higher if it were not for the administration of naloxone, the life-saving antidote for an opiate overdose victim. Another disturbing fact is that many overdose victims revived with naloxone quickly return to using opiates and have to be repeatedly revived.

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One example is a young woman in Ohio who overdosed six times. In this particular case, the patient was revived each time with naloxone. Furthermore, she started using opiates again within 24 hours of having been released from the hospital after her sixth overdose.

The Fallout of Repeat Overdose: Compassion Fatigue

Reviving repeat victims of opiate overdoses has caused a phenomenon among medical professionals known as “Compassion Fatigue”. First responders such as paramedics, ER doctors, nurses, and staff end believe they are contributing to a never ending cycle. A consequence of this trend to overdose time-and-again is to provide treatment without hope, treatment without empathy.

Opiate overdoses are so rampant in Ohio, for example, that emergency medical responders treated nearly 13,000 overdose patients with Naloxone in 2014, the most recent data available from the Ohio Emergency Medical Services. Put yourself in the shoes of the teams that revive and help overdose victims. Could you continue to provide the same level of care for the same person over and over? Where would you draw the line in terms of emotional investment?

Problems Tracking Rx Prescriptions

To continue our discussion, we’ll need to take a look at the current landscape of how drug overdoses are currently addressed in the U.S. One noteworthy occurrence contributing to this epidemic is that the majority of patients who have survived an opiate drug overdose continue to receive opioid prescriptions. The fact is that most physicians who prescribe opioids to patients who previously overdosed are unaware of the addiction and the overdose.

In order to prevent this from happening, overdose occurrences must be documented in a central database that is accessible to physicians, similar to the PDMP (Prescription Drug Monitoring Program).

According to a Boston Medical Center study of chronic pain treatment, more than 90 percent of people who survived a prescription opioid overdose were able to obtain another prescription for the same drugs that nearly killed them. The study also found that 70 percent who survived an overdose were prescribed opioids again from the same physician.

Tracking A New Way Forward

I offer you this idea. I think that repeat drug overdose can be prevented by creating a database which physicians can access that tracks overdose patient information. The system would need to be implemented in all hospitals and emergency rooms nationwide. The potential outcome?

Imagine the following scenario.

  1. A person overdoses on opioids a second time.
  2. Tracking systems help in recognition of patterns in drug use and flag the case.
  3. Red flags then trigger brief interventions and referral to addiction treatment.
  4. Red flags also trigger step-down detox processes for Rx opioid medications. Opiate replacement therapies such as buprenorphine can be prescribed; drug prescription shifts from pain killers to medication assisted treatment for addiction.
  5. System wide professionals – doctors, pharmacists, counselors – are all notified of the overdose and encouraged to take actions.

But what kinds of medical providers should be involved in this process?

One medical expert believes most emergency physicians do not have the expertise to treat the addiction. In many cases, patients are released only to return to their opiate addiction.

Another step that must be taken to combat the opiate crisis is to employ an addiction specialist in every emergency room throughout the country. Addiction specialists can immediately begin medication assisted treatment for overdose survivors and refer the patients to addiction counseling prior to their release from the hospital. But medical professionals aren’t the only ones who can help!

According to SAMHSA, the Substance Abuse and Mental Health Services Administration, peer support services can help, as well. In this cases, referral services are delivered by individuals who have common life experiences with the people they are serving. People who have been diagnosed with mental and/or substance use disorders and gone through treatment have a unique capacity to help each other based on a shared affiliation and a deep understanding of this experience. To date, The Wisconsin Voices for Recovery group is currently implementing a peer support system in emergency rooms referred to as ED2 Recovery. The main goals of the program are to:

  1. Increase treatment utilization.
  2. Reduce Emergency Department recidivism.
  3. Decrease the number of overdose fatalities in Wisconsin.

This should be done in every emergency room in the country!

Addiction Treatment in the ER

So, can these ideas work? Initial trials have shown success.

A 2015 study by researchers at the Yale School of Medicine found that opioid-dependent patients had better success rates in treatment for opioid addiction if the treatment was initiated during their emergency room visit. These patients were given an initial dose of buprenorphine at the hospital with additional doses to take home and a scheduled appointment with a primary care provider who could continue the buprenorphine treatment within 72 hours.

Buprenorphine, commonly known as Suboxone, has been very effective in the treatment of opioid use disorder.

The study concluded that 78% of patients addicted to opioids who began this type of treatment – medication-assisted treatment – before leaving the hospital were still in treatment for recovery thirty days later.

The Con’s

There will be some privacy advocates that will be adamantly against creating a database with patient overdose information. The cost of this database and employing an addiction specialist at every emergency room would be excessive. However, America has never experienced such a drastic health epidemic as the opiate crisis. Drastic measures must be taken to combat this unprecedented event.

Implementing an overdose database may be as simple as adding a new section to the PDMP database to alleviate the cost of developing an entirely new system. Or, a new database is required. In whatever form it takes, a database tracking drug overdoses across the U.S. is an actionable, direct way to face the Opiate Crisis head on.

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About the Author: Practitioners who desire to have their practice audited for DEA compliance relative to prescribing controlled substances, or if you would like to receive training on the diversion of pharmaceutically controlled substances from retired DEA Special Agent Drug Diversion Expert Warren Rivera, please visit www.trainingidea.com or https://www.linkedin.com/in/warren-rivera-aa4a3221
Reference Sources: Boston Globe: Most Patients Who Survive Overdose Get More Opioid Prescriptions
The Atlantic: It’s easy to get Opioid Prescriptions After An Overdose
NPR: Hospitals Could Do More For Survivors Of Opioid Overdoses, Study Suggests
CNN: Doctors increasingly face charges for patient overdoses
CDC: Drug overdose deaths in the United States continue to increase in 2015
Blog- Iodine: How naloxone saves lives — and why it’s so controversial
EMS1: Officials question naloxone use on repeat overdose patients

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About Warren Rivera

Warren Rivera is a retired Assistant Special Agent in Charge from the U.S. Drug Enforcement Administration. Mr. Rivera is an experienced public speaker, trainer and an expert in the diversion of pharmaceutical controlled substances. Mr. Rivera currently owns Training Idea, LLC, a private consulting firm that provides training on DEA matters to the healthcare industry, law enforcement and the community.

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