The Epidemic Inside the Pandemic
For the past 12 months, the nation’s medical community correctly and understandably focused nearly all its attention on the COVID-19 pandemic. Now with millions being vaccinated, we are seemingly turning the corner and are returning our focus to a different health crisis that never went away and got worse during COVID.
The Opioid Crisis continued to loom over the U.S. and even get progressively worse due to the limited resources during the pandemic. Research shows that more than 13% of American adults started or increased substance use to cope with stress related to COVID-19. Unfortunately, many of the socially isolating steps that were necessary to combat COVID-19 are the same conditions where substance abuse flourishes.
In Alabama, Jefferson County alone saw drug overdose deaths increase by 25% in 2020, reaching the highest percentage increase ever. This mirrors national data, with the Centers for Disease Control (CDC) reporting the highest number of fatal overdoses ever recorded in the U.S. in a single year in the 12-month period ending in May 2020. It’s likely the U.S. will surpass 100,000 drug overdose deaths this year for the first time ever.
Understanding the Opioid Crisis
More than 10 million Americans (age 12+) are reported misusing opioids in 2018. The most shocking statistic is that 9.9 million were reported using prescription opioids. Alabama has led the nation for the past six years in the opioid prescribing rate per 100 population (121 in 2016, 107.2 in 2017) and had nearly three times more opioid prescriptions per 100 population than New York (CDC.gov). We are working with the CDC and other states to take statistics like these and turn them into action that ultimately reduces overdose deaths.
The opioid crisis is a public health and economic crisis that is eroding the quality of life for Alabama residents. People are dying and families are being devastated. It impacts every sector of our economy, including healthcare, education, business, and local governments. The opioid crisis recognizes no neighborhood, no race, and no class. It is neither limited to backstreets in urban settings nor isolated in rural communities.
Drug overdose deaths are alarmingly continuing to increase in the U.S. In fact, nearly 71,000 people died from drug overdoses, in 2019, making it a leading cause of injury-related death in the United States. Of those deaths, over 70% involved a prescription or illicit opioid.
What can be done to make sure people are cared for while not harming them at the same time?
The CDC Guideline addresses patient-centered clinical practices including conducting thorough assessments, considering all possible treatments, closely monitoring risks, and safely discontinuing opioids.
The three main focus areas in the Guideline include:
- Determining when to initiate or continue opioids for chronic pain
- Selection of non-pharmacologic therapy, nonopioid pharmacologic therapy, opioid therapy
- Establishment of treatment goals
- Discussion of risks and benefits of therapy with patients
- Opioid selection, dosage, duration, follow-up, and discontinuation
- Selection of immediate-release or extended-release and long-acting opioids
- Dosage considerations
- Duration of treatment
- Considerations for follow-up and discontinuation of opioid therapy
- Assessing risk and addressing harms of opioid use
- Evaluation of risk factors for opioid-related harms and ways to mitigate patient risk
- Review of prescription drug monitoring program (PDMP) data
- Use of urine drug testing
- Considerations for co-prescribing benzodiazepines
- Arrangement of treatment for opioid use disorder
Responsible Prescribing Can Save Lives
A prescription drug monitoring program (PDMP) is an electronic database that tracks controlled substance prescriptions. PDMP’s can help identify patients who may be misusing prescription opioids or other prescription drugs and who may be at risk for overdose. Clinical practice guidelines encourage the use of the PDMP prior to prescribing to assess a patient’s history of controlled substance use.
It is possible to improve the way opioids are prescribed, reducing the number of people who misuse, abuse, or overdose from them, while making sure patients have access to safe, effective pain management. PDMPs can alert you to prescription information requiring interventions that could be lifesaving. Take action to improve patient safety.
Check the PDMP. It’s an important step to improve opioid prescribing practices.
- Do not dismiss patients from care
- Calculate the total daily dose of opioids for a safer dosage
- If patients are receiving high total opioid dosages
- Consider collaborating with the patient to taper opioids for chronic painto a safer dosage
- Consider offering naloxone
- If patients are taking benzodiazepines with opioids
- Communicate with others managing the patient
- Weigh patient goals, needs, and risks
- If considering opioid use disorder, discuss safety concerns and treatment options
Make sure you know all the risks and benefits of treatments and how to reduce the risk of opioid addiction and overdose.
- Make sure you’re getting the care that is safe, effective, and right for you. Talk with your doctor about setting goals for your pain management.
- Talk with your doctor about acute pain, chronic pain, and how to avoid addiction.
- Ask your doctor about non-opioid optionsfor treating pain, including medications other than opioids as well as nonpharmacologic options, like exercise.
- Always let your doctor know about any side effects or concerns you may have.
- Pain medications are safe and effective when used as directed. However, misuse of these products can be extremely harmful and even deadly.
- Do not change the dose of your pain relief medication without talking to your doctor first.
- Pain medications should never be shared with anyone else. Only your health care professional can decide if prescription pain medication is safe for someone.
- Keep medicines in a safe and secure place.It’s best to store opioids in a place that is locked, like a keyed medicine cabinet or drawer, to keep them secure from children, family, friends, and visitors.
- Properly discard expired or unused prescription opioids.Remove them from your home as soon as possible to reduce the chances of misuse. To get rid of prescription opioids and other medications safely.
Drug Disposal: Drug Take-Back Locations
Medicine take-back options are the best way to safely dispose of unused or expired prescription and nonprescription (for example, over-the-counter) medicines.
Before disposing of prescription medicines, be sure to remove all personal information on pill bottle labels and medicine packaging. All of your medicines dropped off at the take-back locations will be destroyed.
- Find a medicine take-back option near you: DEA.gov
- Check with your pharmacist to see if you can return unused medication to the pharmacy.
- Take Back Alabama: Did you know there are Walgreens locations where you can safely dispose of your unused over-the-counter and prescription medications year-round? Find a location near you.
Signs of trouble? How to Seek Help
Opioids can affect your thinking and judgment. Even when you take an opioid medication as prescribed, you might make decisions too quickly, without thinking things through. You may think you’re OK and you’re making good decisions when you’re not. You may take risks and put yourself and others in danger.
In addition, if you or a loved one is currently taking opioid medications, stay on the lookout for signs of trouble. Signs of opioid abuse include:
- Regularly taking more than the prescribed dose of medication
- Taking pain medication “just in case,” even when you’re not in pain
- Mood changes
- Borrowing medication from other people, or using medication prescribed for someone else
If taking opioids becomes the center of your life, tell your doctor how the medication is affecting you.
Stopping Opioids Safely
Don’t try to go off opioids cold turkey, on your own. That’s a recipe for failure and puts you at risk of serious health consequences. If you’ve become dependent on opioids or prefer to stop using them, ask your doctor for a safe plan of action. There are many nonopioid alternatives to help you manage your pain. Opioids are responsible for more deaths than any other medication or drug. Withdrawal can be life-threatening.
Medical Detox encompasses both pharmacological and psychological treatment in a safe and comforting residential setting. Vital signs, such as blood pressure, respiration levels, body temperature, and heart rate, need to be closely monitored.
How New Outlook Detox Can Help
In cases where the risk of death while detoxing is too great, medication-assisted treatment may be a way to wean your system off of harmful substances. MAT is recognized as a useful stepping stone towards recovery and a life of full sobriety. When paired with counseling, medication-assisted treatment has seen success in helping people achieve sobriety who may not have been successful going cold-turkey. Learn more about Medication-Assisted Treatment on the Family Life Center website and contact them today to learn more.