How did we get here, anyway? I refer to the national epidemic of prescription opioid abuse. The numbers, of which most of us are well aware, are staggering. According to the CDC, the number of opioid prescriptions has risen from 76 to 219 million nationally. These statistics are mirrored by ED visits related to misuse or abuse of prescription drugs, drug poisoning (overdose) death rates and economic costs. Opioid abusers generate, on average, annual direct health care costs 8.7 times higher than non-abusers. In the outpatient primary care environment, clinicians are painfully aware of the enormity of this epidemic faced with so many of the patients we see.
What has been largely overlooked is the problem of inpatient opioid management. The hospital environment has traditionally not been studied although the concern for the quantity of, and rationale for, opioid dosing has been a recognized problem for some time.
The good news is that there is a path forward. Seven months ago, the QOC authorized staff support for our inpatient opioid therapy project, led by Nancy Boutin, M.D., and myself. The multi-disciplined committee has concluded work on patients admitted on methadone management and, with the knowledge gained from the creation of an order set for these high-risk individuals, are now tackling patients with gastro paresis, primarily type 1 diabetics and patients with inflammatory bowel disease, and cyclic vomiting.
Our intent in the remaining half-year is to finish our work with other broad categories of pain diagnoses, including post-surgical patients. The goal is to provide pharmacologically sound treatment algorithms for our clinicians and a consensus-driven backstop for our colleagues who have the challenging task of responding to patient requests for these medications.
Nancy and I have reached out to colleagues in fellow institutions for assistance and have not been able to discover other such programs in place. It is a credit to our QOC that this exciting progress forward is happening. In a later column, I will keep you updated on our work. All my best.