The Hospital’s Role in the Opioid Crisis

The opioid epidemic is ballooning into an increasingly critical crisis, one with a high cost in human lives, hospital beds and healthcare expenses. According to the Center for Disease Control (CDC), 115 Americans die every day from an opioid overdose, which includes both prescription opioids and illegal opioids like heroin. In 2016, the number of deaths related to opioid overdose was five times the rate in 1999. The trajectory is staggering. And opioid abuse isn’t relegated to one facet of the population; instead, the problem spans age, gender, social class and geography, devastating communities across the country.

The massive scale of the opioid crisis spurred legislation designating $1 billion in federal funding to expand treatment and support overdose prevention; however, with parts of the Affordable Care Act repealed by Congress, Modern Healthcare reports that hospitals may have to foot the bill if patients drop coverage and then need to be resuscitated from an overdose in the Emergency Room (ER). A 2017 study across 44 states and 162 hospitals found the cost to treat patients for an overdose in hospital intensive care units spiked by 58% between 2009 and 2017, increasing from an average of $58,517 to $92,408 per patient.

Although the large-scale, explosive trajectory of this crisis is grim, hospitals can play a crucial role in combating the opioid epidemic by establishing six core practices.

Use Other Methods of Pain Management

It’s not a leap to realize one key contributor to the opioid epidemic is prescriptions when the CDC notes that alongside a spike in opioid overdoses, the rate of opioid prescriptions has quadrupled from 1999 to 2015. A study from Harvard T.H. Chan School of Public Health and Harvard Medical School found that emergency room physicians who prescribed opioids more often than their peers increased the risk of long-term opioid use and additional adverse effects. Long-term use is linked to misuse, addiction or overdose at higher rates. The study also found that the prescription practices among physicians ranged widely: in some cases, patients who saw high-intensity opioid prescribers were three times as likely to receive an opioid prescription as a patient who saw a low-intensity prescriber – even within the same hospital.

At Chicago’s Rush University Medical Center, the hospital hopes to control the crisis by replacing opioid prescriptions with oxycodone, anti-inflammatory drugs, Tylenol and other pain medicines like gabapentin, an epilepsy drug that can also help manage pain, as they discharge patients. During surgery, the center is also reducing the number and dosage strength of opioids prescribed.

Hospitals can address inconsistent or excessive prescription by establishing guidelines and practices to facilitate more limited pain management solutions, adding warnings to electronic health records regarding the risks of opioid use and creating a system for hospital leadership to assess prescription records and hold physicians accountable. For example, in Wisconsin’s Gunderson Health System, patients sign a three-page agreement before they can receive their pills – and they can’t receive the opioids if they are facing criminal charges, fail a urine screening or miss an appointment.

Prescribe or Dispense Naloxone

Opioid use disorder is a disease – one that can be treated when physicians prescribe patients at high risk of overdose naloxone, which reverses an opioid overdose. Equipping families or caretakers who support at-risk patients with naloxone doses may also help save lives in the future. According to Partnership for Drug-Free Kids, naloxone is safe even for someone who has overdosed on other drugs (though this drug is only known to reverse opioid overdose).

Raise Awareness About the Addiction

Hospitals should educate family, support systems and patients on chronic pain and pain management practices so they are aware of the risks of opioid abuse. In addition, educating prescribing physicians on safe opioid prescribing is a vital way to curb the crisis. One example of this practice is the healthcare network Kaiser Permanente, which requires its first-year physicians in Southern California to complete free online training. Thanks in part to this program, Kaiser Permanente has achieved a 91% reduction in the amount of high-volume opioid prescriptions over three years for non-cancer, non-palliative pain. In addition, the healthcare provider urges its physicians to avoid prescribing brand-name opioids, as those have higher value, and therefore are more likely to permeate the streets. Kaiser Permanente realized a 95% reduction in the net number of brand name opioids when a generic option was available.

Target the Emergency Room

Many substance abusers are also chronic users of the ER, yet patient information isn’t always current and budgets to support these patients are increasingly tight. In Washington state, a collective of ERs banded together to launch the ER for Emergencies program, aimed at reducing ER visits. One critical step in pursuing that objective was leveraging a technology platform that allows healthcare professionals to view data from an array of sources and identify high users of the ER. The system also offers prescription management recommendations. In a single system, complex visits can also be addressed more immediately by case managers or other professionals who could support patients with heart failure, sickle cell disease or schizophrenia. In 2015, the Brookings Institution reported the ER for Emergencies program had cut visit rates from frequent ER users by 11% and reduced prescriptions for controlled substances by 24%.

Hospital leaders can also ensure physicians in the ER take the opportunity to educate patients admitted because of an overdose. By offering overdose education, dispensing naloxone and advocating for opioid use disorder treatment on the spot, physicians can support patients who may have no other contact with the broader healthcare system.

Treat the Addiction

Instead of referring patients to a provider in the community for addiction treatment, physicians can initiate treatment during the visit, potentially lessening chances for patients to avoid or forget about treatment. In some cases, hospitals and community-based providers are using other people in addiction recovery as peer recovery specialists to support patients who are diagnosed with a substance abuse disorder.

Work With the Community

Launching treatment on site isn’t to say hospitals shouldn’t partner with community-based providers and partner with all disciplines to combat the opioid epidemic. In fact, hospitals can help facilitate community education for prevention and substance use disorder management.

Hospitals should focus on prevention, awareness, and community outreach, partnering with local law enforcement, public officials, schools, social services, first responders and public health departments on these areas. For example, law enforcement most often is the first on the scene for opioid-related overdoses. Safe disposal united established by community partners can facilitate properly disposing of opioids. Finally, the partnership between clinicians and case managers ensures a necessary flow of information for cases that may include child welfare.

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