Salt Lake City—According to the Centers for Disease Control and Prevention, 91 Americans die every day from an opioid overdose. In Utah, deaths from prescription medications increased 400 percent from 2000 to 2014. Utah has been as low as fourth-worst in the nation for drug overdose deaths, but currently sits at eighth-worst as numbers across the country continue to climb.
A group of nearly a dozen healthcare professionals talked about the growing American (and Utahn) opioid epidemic at downtown Salt Lake City’s Holland & Hart offices on Wednesday morning: reasons why it exists and what the healthcare industry can do to curb the numbers. The conversation was part of Utah Business’ annual healthcare roundtable discussion where topics such as medical marijuana, population health, Medicaid and others were also canvassed.
Joe Miner, executive director of the Utah Department of Health, did not mince words on the gloomy situation. “Over the last 15 years, the prescribing of opioids—the general number of pills out there—has increased five-fold, 500 percent,” he said. “The pills are out there to use some, and then to share with friends and neighbors and particularly for kids to use for recreational purposes. Fifty-one percent of individuals addicted to opiates became addicted from medication that wasn’t even their own. The pills are just out there.”
Taking note, Intermountain Health has pledged to reduce opioid prescriptions by 40 percent in 2018—”a lofty goal”, says VP of outreach services for Intermountain Healthcare, Jim Sheets. That’s a reduction of 5 million pills.
Part of the problem, said Sheets, is the lack of education with both patients and healthcare providers. Providers may feel a sense of responsibility to keep their patients completely pain-free, while patients do not realize how potentially addictive the pills are. A full slate of 30-40 pills may be prescribed to a patient coming out of surgery who only realistically needs six.
And the problem comes back to the hospitals, too. Sheets said 30-35 percent of patients in the emergency room of LDS Hospital (of which he was recently CEO/Administrator) were there with mental health or substance abuse problems.
“It’s starting to fill up and clog up your emergency rooms and it just has a real downstream effect that’s difficult for the healthcare system,” he said.
However, reducing the number of pills in the community may not fully cure the problem, said Miner. A huge percentage of people addicted to opiates were on prescription pills initially, and that many continue on to heroin when they can no longer find the pills. Heroin use, he said, continues to climb in Utah even as opiate prescribing begins to decline.
“They’re definitely replacing the opioid prescription pills addiction. So it’s critically important that people with an opiate addiction not be abandoned, that they be helped to maintain and get off or have some treatment that helps them deal with their addiction, and that we prevent adding new people to this addiction cycle,” he said.
Both patients and providers need to be reoriented and educated, said Michelle McOmber, CEO of the Utah Medical Association, to understand that some pain is better than opioid addiction.
“It’s a complete paradigm shift to say that you can have pain, that we don’t need to reduce all of your pain, and that we can reduce the amount of prescriptions that we’re giving you,” she said. “And we have seen that shift. It’s slower, I think, than what we wanted to see originally, but we also didn’t get to the point where we are overnight.”
Looking to the future, researching addiction properties in humans and looking at potential pain-managing opioid alternatives should also take the stage, said Ed Clark, AVP of Clinical Affairs at the University of Utah, and Brent Williams, CEO of Dental Select.
“Joe [Miner] and I learned now to treat measles [as physicians]—we don’t have to treat measles anymore,” said Clark. “We need to apply that same paradigm, understanding the etiology, what are the risk factors—using that information so that we can prevent, not just treat, this crisis of opioid and heroin addiction. That’s basic research.”
For Williams, studying potentially safer drug alternatives can help tamp down the nearly three million individual opioid pills prescribed in excess of what’s needed to treat dental pain.
“A study just came out in the last month where they were looking at a combination of acetaminophen and a certain dose of caffeine with it that would reduce the swelling enough to reduce the pain so they don’t need opioids,” said Williams. “That one has started to get some traction in the dental community right now. I think there’s got to be alternatives to opioids, and we need to look at other ways of solving this. ”
The conversation was moderated by Dave Gessel, executive VP at the Utah Hospital Association. Read the full conversation in the December issue of Utah Business.