Rise in Opioid Overdoses – Prevention Strategies
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Over the past two decades, opioid overdose has become a major public health problem in the United States and a leading cause of injury or death among people. As per reports from the Centers of Disease Control and Prevention (CDC), about 43,982 drug overdose deaths were reported in the United States in the year 2013. It is estimated that every day in the US, 114 people die as a result of drug overdose and another 6,748 are treated in emergency departments for the misuse or abuse of drugs. Nearly 9 out of 10 poisoning deaths are caused by drugs (both illicit and prescribed). Overdose can happen to both men and women of all age groups, ethnicities and demographic and economic characteristics. Opiates include illicit drugs like
heroin
and
prescription
opioid
analgesics
such
as
oxycodone,
hydrocodone, fentanyl, and methadone among others. Overdose can happen when a patient intentionally misuses a prescription opiate or an illicit drug. It can also occur when a patient consumes the medicines (as directed by the physician), but the prescriber miscalculated the dosage or a mistake was made by the dispensing pharmacists or directions for use was misunderstood by the patient. Problems can also occur when a person combines opiates (prescribed or illicit) with alcohol, other medications or over-the counter products that may cause problems in breathing, lower heart rate and other functions of the central nervous system.
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How to Prevent Drug Overdose – Physicians’ Role
Physicians and healthcare providers play a crucial role in preventing the cases of drug overdose. Before treating new patients, physicians need to evaluate the patient’s medical history including the current and past use of medicines, types of medicines consumed, dosage and frequency of use and route of administration. In addition, they should enquire about the use of alcohol or tobacco and over-the-counter (OTC) preparations. On the other hand, people with mental health problems or with histories of substance abuse should be given special attention by pain management physicians. In such cases, medication-assisted treatment combined with regular counseling and other supportive services may help patients to lead a healthier life. Moreover, regular follow-ups at least once in 1-2 months may also help prevent future risks. PDMP (State Prescription Drug Monitoring Programs) have surfaced as a key strategy in addressing the problem of misuse and abuse of prescription opioids and thus preventing overdoses and deaths. With this program, prescribers can easily check their state’s PDMP database and verify whether a patient is filling the prescriptions provided and obtaining the correct prescriptions for the same or similar type of drug from different physicians. www.outsourcestrategies.com
It is important for healthcare providers and physicians to regularly update their knowledge about evidence-based practices for the use of opioid analgesics for pain management and take specific steps to reduce cases of overdoses. Accurate documentation of diagnoses and provided services using appropriate diagnostic and procedural codes is vital both from the point of view of patient care and from that of obtaining due reimbursement via accurate medical billing. The following ICD-9 codes are used to report opioid overdose – E850.1 - Accidental poisoning by methadone E850.2 – Accidental poisoning by other opiates and related narcotics E935.1 - Methadone causing adverse effects in therapeutic use E935.2 - Other opiates and related narcotics causing adverse effects in therapeutic use E980.0
-
Poisoning
by
analgesics,
antipyretics,
and
antirheumatics,
undetermined whether accidentally or purposely inflicted 965.0 - Poisoning by opiates and related narcotics E850.0 - Accidental poisoning by heroin E935.0 - Heroin causing adverse effects in therapeutic use High Opioid Doses Linked to Increased Depression –Finds Study
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A new study reports that patients taking higher doses of opioid medicines to manage chronic pain are more likely to experience an increase in depression over time. The study conducted by researchers at the Saint Louis University was published in Pain, the Journal of the International Association for the Study of Pain (February 2015 edition). The study expands the researchers’ findings in a previous study of Veterans Administration (VA) patients. Generally, depressed patients over time consumed more opioids. Researchers wanted to identify whether this high-dose usage was one of the primary reasons why pain patients experienced higher rates of depression. They studied more than 355 primary care patients (mainly white and middle-aged women) being treated for chronic low back pain (at nine clinics across the Residency Research Network of Texas). The patient levels of depression along with pain, anxiety, health-related quality of life and levels of stress and social support were self-reported at baseline and at 1-2 years of follow-up. The patients who were surveyed included 72.4 percent female, older than 46 (75.2 percent) and mostly of Hispanic or African-American descent (57.5 percent). In addition, they reported the total number of years they had suffered acute pain. Researchers collected information on opiate type and usage and comorbid conditions from patient records. This was done to primarily assess the direct association between changes in the opiate dosage (0, 1-50 mg, and greater than 50 mg daily) and probability of depression over time, as well as the change in depression levels and the odds of increased opioid dosage.
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It was found that better understanding of temporal relationship between opioids and depression and dosage of the opioids (that places the patients at higher risk for this condition) may help physicians in better prescription, pain management and improve outcomes for patients suffering from debilitating pain.
Researchers consider that treating depression or reducing morphine
equivalent dose (MED) may mitigate a bi-directional association and eventually improve pain management.
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