For the past year, U.S. providers have had their hands full battling two public health crises — the Covid-19 pandemic and the opioid epidemic.
Despite the challenges brought on as a result of the pandemic, providers have pressed on with their efforts to address the opioid crisis. These include reaching out via telemedicine to support patients in recovery, changes in the law, establishing programs that make a key anti-overdose medication more accessible and putting strategies into place to curtail opioid prescribing.
Prior to the pandemic, prescription drug misuse and abuse was perhaps the biggest public health crisis facing the U.S., and the situation has not improved since. There were 81,000 drug overdose deaths recorded in the 12 months leading up to May 2020 — the highest number of overdose deaths ever recorded in a year-long period, according to the Centers for Disease Prevention and Control. Synthetic opioids appear to be the primary driver of the increase in overdose deaths, rising 38.4% in the same time period compared with the year prior.
Access to addiction recovery and 12-step programs has emerged as a big hurdle for patients struggling with opioid use disorder.
“Social isolation has been devastating for our patient population who relies on peers to help guide them through challenging times,” said Dr. Andrea Caputo, clinical educator at Boston Medical Center’s Office-Based Addiction Treatment Training and Technical Assistance Program, in an email. “Many in-person peer support groups have been put on hold and treatment facilities may be at a reduced capacity because of Covid restrictions. The stress, loneliness, job loss, housing insecurity and virtual homeschooling associated with the pandemic have also been a challenge for many in recovery.”
Similar to clinical care, providers leaned on telemedicine to connect with and care for opioid use disorder patients.
Boston Medical Center engaged patients through phone and video visits to ensure that they were able to get the treatment and support they needed, said Annie Potter, clinical nurse educator with the hospital’s Office-Based Addiction Treatment Training and Technical Assistance Program, in an email. They gave their patients the option to participate in virtual peer support groups, speak with recovery coaches or receive one-on-one therapy.
Changes in legislation also allowed providers to prescribe buprenorphine — a treatment for opioid use disorder — via telehealth, which helped immensely, Potter added.
Baltimore-based Johns Hopkins Medicine went one step further and established a program that would put Naloxone, an opioid overdose reversal drug, directly in the hands of at-risk patients.
Launched three months ago, the program involves giving Naloxone kits to patients who come into their emergency departments with opioid use disorders or having overdosed on opioids, said Dr. Michael Fingerhood, associate professor of medicine and public health at Johns Hopkins University, in a phone call.
“The impact, I think, is huge,” he said. “If you just give a patient a prescription [for Naloxone] that person will likely not fill it.”
Like Boston Medical Center, Johns Hopkins also made greater efforts to provide support to opioid use disorder patients. Their community workers and physicians checked in on patients more frequently as they knew the usual support programs weren’t in place, especially early on in the pandemic. They also encouraged patients to attend 12-step programs via Zoom, though some patients felt it was not the same as in-person meetings, Fingerhood said.
But strategies to reduce harm and treat opioid use disorder are just one-half of the equation. The other is to curb the number of opioids being prescribed in the first place.
This is what Ochsner Health System in New Orleans has been focusing on for the past five years. The provider linked its EHR to the state’s prescription drug monitoring program’s database so clinicians could seamlessly access opioid prescription data, said Dr. Jason Hill, the health system’s associate chief medical information officer, in a phone interview. The database tracks controlled substance prescriptions in a state.
Previously, connecting to the database was a time-consuming process for physicians, involving three or four passwords. Ochsner used technology from Appriss Health to link its EHR to the database so that physicians could access the data with just one click.
“Instead of just prescribing the medication, the physician is now taking the time to look and see what the patient is already taking,” Hill said. “Are they already in a prescription monitoring program? Do they already have an opioid contract?”
Further, Ochsner started collecting and sharing the prescribing rates of its physicians.
“Doctors, by nature, are competitive individuals,” Hill said. “So when you start to compare prescribing rates of people within the same practice group or section, people want to try and compete to get better. And that competition only works out for the benefit of the patient.”
As a result of these efforts, prescribing rates were down for Ochsner physicians even during the pandemic, he said.
Now the health system is turning its focus to making opioid use safer for patients who require high doses of the medication by enrolling them in pain management programs, implementing regular urine drug screenings and increasing the prescription of reversal agents like Naloxone.
The opioid epidemic existed long before the pandemic and will likely be with us until long after. As providers navigate Covid-19, they are also leveraging virtual technology amid other strategies to keep their feet on the gas pedal and control substance abuse in their communities.
Photo: Jeffrey Hamilton, Getty Images
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