Once again Congress is GIVEN A PASS over their contributions to the opiate crisis in the early 2000’s.  In 1999-2000 Congress passed the DECADE OF PAIN LAW… and The Joint Commission (JC) got involved and declared that pain was THE FIFTH VITAL SIGN – on par with the importance of  a pt’s Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure.  JC made adequate pain management a MAJOR STANDARD for hospital to meet in order to attain certification by the JC.  Pt surveys given to pts on being discharged from the hospital were required to have questions about how their pain was treated while in the hospital. When the Decade of Pain Law expired, the politically party in the majority of Congress had FLIPPED and refused to renew the law.  Once that law was not renewed, JC disavowed any ownership of the 5th vital sign and pain was no longer a major standard for hospitals to meet when pts were in the hospital.  I guess that is no small coincidence that the number of opiate Rxs peaked a couple of years after the Decade of pain law expired and have continued to drop annual ever since.  Currently about 60% less from the earlier peak. While OD/poisoning from illegal fentanyl has increased around FOUR TIMES in a similar time frame. 

The Opioid Crisis Is Still a National Threat

https://www.medpagetoday.com/opinion/focusonpolicy/101502

Its shape is changing slightly, but we must continue to battle this scourge

Midterm election madness is in full swing and the incipient cold/flu/COVID season is looming. Our national opioid epidemic has largely disappeared from the headlines with the exception of local coverage when drugs are associated with a crime.

How are we faring in this longstanding battle?

First, a brief recap of what brought us to this point. Beginning in the late 1990s, pharmaceutical company misinformation about the addictive properties of opioid pain medications led providers to prescribe them at higher rates. This precipitated an alarming increase in the use and misuse of these highly addictive medications and, in 2017, prompted the Department of Health and Human Services to declare a public health emergency.

Since then, a great deal of effort and financial capital has gone into understanding the “upstream” conditions that fueled the crisis, and implementing interventions to resolve problems. However, the challenges are formidable; for instance –

• Addressing social determinants such as poverty, joblessness, disparities, and crime
• Changing long-established provider prescribing practices
• Disrupting the supply chain for illegal manufacture and distribution of deadly opioid and synthetic preparations on a nationwide basis

On the “downstream” side, some interventions have been effective in preventing deaths and reducing recidivism. Consider the relative speed with which opioid antagonists (i.e., naloxone and naltrexone) have become an integral part of training for many police officers, emergency medical technicians, and non-emergency first responders. In fact, most states now permit people who are at risk — or who know someone at risk for an opioid overdose — to be trained in administering naloxone. There has also been a sizable uptick in the availability of mental health support services and medication assisted treatment options for people who have experienced a non-fatal opioid overdose.

So, back to my original question: are we any closer to winning the battle?

A quick scan of recent national statistics suggests that, rather than abating, the crisis may be undergoing a subtle transformation. A Substance Abuse and Mental Health Services Administration survey estimates that 9.5 million Americans age 12 and over misused opioids in 2020, down from 10.1 million the previous year. While this is encouraging, the survey data also show a disturbing increase in heroin use.

National hospitalization and mortality data provide a more robust assessment of the situation. From 2010-2018, opioid-involved overdose deaths rose from 21,088 to 46,802 in the U.S. Recent statistics paint an increasingly bleak picture. During the first year of the COVID pandemic, there was an increase of 30.6% in 12 months (68,630 overdose deaths through 2020). The increase was not confined to a few hot spots; statistically significant increases in drug overdose death rates were reported in 40 states.

Homing in on a specific locale, the Pennsylvania Health Care Cost Containment Council recently released its report on opioid overdose hospitalization trends in the state. In addition to differentiating between pain medication and heroin overdose hospitalizations, the report highlights trends across race/ethnicity and poverty levels from 2016 to 2021.

Over the 6-year period, there are indications that the crisis as we know it might be waning. For example, there was a 27% decrease in hospitalizations for opioid overdose (from 3,342 in 2016 to 2,429 in 2021), and the percentage of overdose hospitalizations associated with heroin also declined (from 47% of cases in 2016 to 30% of cases in 2021).

Analysis of demographic data suggests a worsening of “upstream” conditions. While hospitalization rates for opioid overdose decreased in the white, non-Hispanic population, they increased for both Black and Hispanic residents. Similarly, increased rates over time were observed for residents living in high-poverty areas (i.e., areas with a poverty rate >25%).

The statistics I find most alarming in this report relate to the drug fentanyl, a powerful and highly addictive synthetic opioid. In 2021, approximately 18% of all opioid overdose hospitalizations were for fentanyl overdose; and, of all opioid overdose hospitalizations that ended in death, 34% were for fentanyl overdose. National data reinforce these concerns; the CDC reports that overdose deaths from synthetic opioids (primarily fentanyl), psychostimulants (such as methamphetamine), and cocaine continued to increase in 2021 compared to 2020.

Inevitably, there is no simple answer to the question I raised. Although national- and state-level reports show hopeful declines in death rates from prescription opioids, the crisis appears to be evolving. We now face the prospect of rising deaths from fentanyl and other addictive substances.

The message is clear. Substance misuse is now –- and will likely remain — a serious threat to national and local population health. We cannot afford to avert our eyes!

Filed under: General Problems